Healthcare Provider Details

I. General information

NPI: 1376285387
Provider Name (Legal Business Name): NICOLE SWEET
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3064 STANTON RD SE APT 103
WASHINGTON DC
20020-7888
US

IV. Provider business mailing address

443 ORANGE ST SE APT 2
WASHINGTON DC
20032-1642
US

V. Phone/Fax

Practice location:
  • Phone: 202-830-9591
  • Fax:
Mailing address:
  • Phone: 202-361-1699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: