Provider Demographics
NPI:1245572205
Name:NOBLE, LIZANNE C (NP)
Entity Type:Individual
Prefix:
First Name:LIZANNE
Middle Name:C
Last Name:NOBLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 WALNUT ST
Mailing Address - Street 2:STE 480
Mailing Address - City:WELLESLEY HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2118
Mailing Address - Country:US
Mailing Address - Phone:781-431-7733
Mailing Address - Fax:781-235-2665
Practice Address - Street 1:65 WALNUT ST
Practice Address - Street 2:STE 480
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481-2118
Practice Address - Country:US
Practice Address - Phone:781-431-7733
Practice Address - Fax:781-235-2665
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2270707363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
043064615OtherTAX ID
003467401Medicare PIN