Provider Demographics
NPI:1043793540
Name:NOE, ANNE ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:ELIZABETH
Last Name:NOE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:ELIZABETH
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 JOHN DEERE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6897
Mailing Address - Country:US
Mailing Address - Phone:309-779-4285
Mailing Address - Fax:309-779-4305
Practice Address - Street 1:600 JOHN DEERE RD STE 200
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6897
Practice Address - Country:US
Practice Address - Phone:309-779-4285
Practice Address - Fax:309-779-4305
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085006722363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085006722Medicaid