Healthcare Provider Details

I. General information

NPI: 1205760550
Provider Name (Legal Business Name): SHARONE TRAIL IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N PARK DR
SULTAN WA
98294-7609
US

IV. Provider business mailing address

210 N PARK DR
SULTAN WA
98294-7609
US

V. Phone/Fax

Practice location:
  • Phone: 206-683-0050
  • Fax:
Mailing address:
  • Phone: 206-683-0050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-310201
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: