Provider Demographics
NPI:1518320571
Name:NOBLE, LISA
Entity Type:Individual
Prefix:
First Name:LISA
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 1:629 N MAIN ST
Mailing Address - Street 2:STE C-3
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-1410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:629 N MAIN ST
Practice Address - Street 2:STE C-3
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880-1410
Practice Address - Country:US
Practice Address - Phone:951-738-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA254024164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse