Provider Demographics
NPI:1225194152
Name:BRICKMAN WILLIAMS, NOELLE ANN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:NOELLE
Middle Name:ANN
Last Name:BRICKMAN WILLIAMS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-5720
Mailing Address - Fax:410-328-1897
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-5720
Practice Address - Fax:410-328-1897
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR062605363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD415687100Medicaid
MD906414-02OtherBLUE SHIELD - MD
DE1225194152Medicaid
MDS062-0339OtherBLUE CHOICE - REGIONAL
MD415687100Medicaid
MD906414-02OtherBLUE SHIELD - MD
P23883Medicare UPIN