Provider Demographics
NPI:1235255175
Name:NOBLE, MARYANN PATRICIA (RN)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:PATRICIA
Last Name:NOBLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 DONELLAN RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-2820
Mailing Address - Country:US
Mailing Address - Phone:631-830-3892
Mailing Address - Fax:
Practice Address - Street 1:1 SAINT JOHNS RD
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-2612
Practice Address - Country:US
Practice Address - Phone:631-723-0138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY548287163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02684426Medicaid