Provider Demographics
NPI:1609967207
Name:WESTRUM, NOELLE ANNE (MD)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:ANNE
Last Name:WESTRUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NOELLE
Other - Middle Name:ANNE
Other - Last Name:NIELSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1012 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2200
Mailing Address - Country:US
Mailing Address - Phone:218-249-7870
Mailing Address - Fax:218-249-7801
Practice Address - Street 1:1012 E 2ND ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805
Practice Address - Country:US
Practice Address - Phone:218-249-7870
Practice Address - Fax:218-249-7801
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
METD979208000000X
IDM7208208000000X
MN51308208000000X
WAMD00042543208000000X
OR18874208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8208068Medicaid
ID804126700Medicaid
ID804126700Medicaid
ID1142573Medicare ID - Type UnspecifiedID MEDICARE