MEDICARE: MS. SHARON MCNICHOLS L.A.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC00228	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1720542749	OTHER	OR	GROUP NPI

General Provider Information

NPI Number	:	1740234103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHARON MCNICHOLS L.A.C.

Provider Business Mailing Address
First Line	:	4670 SW WASHINGTON AVE
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97005-0530
Country	:	US
Telephone Number	:	503-646-8575
Fax Number	:	503-526-0783

Provider Business Practice Location Address
First Line	:	4670 SW WASHINGTON AVE
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97005-0530
Country	:	US
Telephone Number	:	503-646-8575
Fax Number	:	503-526-0783

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	02/25/2019

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