Provider Demographics
NPI:1114573656
Name:NOE, BRENDA
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:NOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:NOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1796 S ROLLING MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46391-3701
Mailing Address - Country:US
Mailing Address - Phone:218-805-0425
Mailing Address - Fax:
Practice Address - Street 1:1796 S ROLLING MEADOWS DR
Practice Address - Street 2:
Practice Address - City:WESTVILLE
Practice Address - State:IN
Practice Address - Zip Code:46391-3701
Practice Address - Country:US
Practice Address - Phone:218-805-0425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty CorpsmanGroup - Single Specialty