Provider Demographics
NPI:1568078343
Name:NOBLE, CHELSEA LEE (AGNP-C)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:LEE
Last Name:NOBLE
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 E LEWISTON AVE
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1316
Mailing Address - Country:US
Mailing Address - Phone:734-308-2130
Mailing Address - Fax:
Practice Address - Street 1:G3371 BEECHER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3621
Practice Address - Country:US
Practice Address - Phone:810-238-3631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAG02200139363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner