Provider Demographics
NPI:1083091326
Name:BURTON, NOELLE ANGELA (PA)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:ANGELA
Last Name:BURTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:NOELLE
Other - Middle Name:ANGELA
Other - Last Name:MENESINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1013 GALLERIA BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-1363
Mailing Address - Country:US
Mailing Address - Phone:916-918-2952
Mailing Address - Fax:916-918-2953
Practice Address - Street 1:1013 GALLERIA BLVD STE 205
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-1363
Practice Address - Country:US
Practice Address - Phone:916-918-2952
Practice Address - Fax:916-918-2953
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA52409363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant