Provider Demographics
NPI:1003355298
Name:BEIERLE, NOELLE MARIE (APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:MARIE
Last Name:BEIERLE
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:NOELLE
Other - Middle Name:MARIE
Other - Last Name:LEBSOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:980 W IRONWOOD DR STE 207
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2668
Mailing Address - Country:US
Mailing Address - Phone:208-755-2804
Mailing Address - Fax:208-765-0277
Practice Address - Street 1:980 W IRONWOOD DR STE 207
Practice Address - Street 2:
Practice Address - City:COEUR D'ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2668
Practice Address - Country:US
Practice Address - Phone:208-755-2804
Practice Address - Fax:208-765-0277
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID54803363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1003355298Medicaid