Provider Demographics
NPI:1477238715
Name:NOBLE, QUETTA
Entity Type:Individual
Prefix:
First Name:QUETTA
Middle Name:
Last Name:NOBLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5539 HUMMOCK RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45426-1403
Mailing Address - Country:US
Mailing Address - Phone:937-789-1286
Mailing Address - Fax:
Practice Address - Street 1:5539 HUMMOCK RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45426-1403
Practice Address - Country:US
Practice Address - Phone:937-789-1286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health