Provider Demographics
NPI:1457673428
Name:STOCK, NOELLE M (RD)
Entity Type:Individual
Prefix:MRS
First Name:NOELLE
Middle Name:M
Last Name:STOCK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:NOELLE
Other - Middle Name:M
Other - Last Name:DODGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1001 WEST STREET
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619
Mailing Address - Country:US
Mailing Address - Phone:315-493-1005
Mailing Address - Fax:315-493-0038
Practice Address - Street 1:1001 WEST STREET
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619
Practice Address - Country:US
Practice Address - Phone:315-493-1005
Practice Address - Fax:315-493-0038
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006705133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered