Provider Demographics
NPI:1407069057
Name:NOLL, PATRICIA JO (LAC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JO
Last Name:NOLL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:17425 HWY 26
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:CA
Mailing Address - Zip Code:95232
Mailing Address - Country:US
Mailing Address - Phone:209-223-2530
Mailing Address - Fax:209-223-3803
Practice Address - Street 1:1140 JACKSON GATE RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-9350
Practice Address - Country:US
Practice Address - Phone:209-223-2530
Practice Address - Fax:209-223-3803
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2635171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist