Provider Demographics
NPI:1114963675
Name:NOKLEBERG, JANE (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:NOKLEBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8305 WALNUT HILL LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4217
Mailing Address - Country:US
Mailing Address - Phone:214-363-7801
Mailing Address - Fax:214-635-3410
Practice Address - Street 1:8305 WALNUT HILL LN
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4217
Practice Address - Country:US
Practice Address - Phone:214-363-7801
Practice Address - Fax:214-635-3410
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2974207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX840358Medicare ID - Type Unspecified
TXG87090Medicare UPIN