Provider Demographics
NPI:1497914147
Name:SHENDER, NOELLE KATALIN (PAC)
Entity Type:Individual
Prefix:MS
First Name:NOELLE
Middle Name:KATALIN
Last Name:SHENDER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5441 WENTWORTH DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4878
Mailing Address - Country:US
Mailing Address - Phone:248-684-9354
Mailing Address - Fax:
Practice Address - Street 1:5441 WENTWORTH DR
Practice Address - Street 2:
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-4878
Practice Address - Country:US
Practice Address - Phone:248-684-9354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-07
Last Update Date:2008-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002343363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical