Provider Demographics
NPI:1144788605
Name:NOBLES, NOLANA
Entity Type:Individual
Prefix:
First Name:NOLANA
Middle Name:
Last Name:NOBLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18640 MACK AVE
Mailing Address - Street 2:P.O. BOX 361243
Mailing Address - City:GROSSE POINT FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-9998
Mailing Address - Country:US
Mailing Address - Phone:313-283-8657
Mailing Address - Fax:
Practice Address - Street 1:28690 SOUTHFIELD RD STE 101B
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-2728
Practice Address - Country:US
Practice Address - Phone:313-283-8657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty