Provider Demographics
NPI:1639248511
Name:REDMON, NOELLE (PA)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:REDMON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14883
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-4883
Mailing Address - Country:US
Mailing Address - Phone:336-379-1156
Mailing Address - Fax:336-370-0442
Practice Address - Street 1:301 E WENDOVER AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1230
Practice Address - Country:US
Practice Address - Phone:336-379-1156
Practice Address - Fax:336-370-0442
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102164363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2751788AMedicare PIN
NC970009624Medicare PIN
S83003Medicare UPIN