Provider Demographics
NPI:1639665037
Name:NOBLES, HEIDIE ELIZABETH (PA)
Entity Type:Individual
Prefix:
First Name:HEIDIE
Middle Name:ELIZABETH
Last Name:NOBLES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:ELIZABETH
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:571 SAINT JOSEPHS BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:607-271-2099
Practice Address - Street 1:100 JOHN ROEMMELT DR FL 3
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8301
Practice Address - Country:US
Practice Address - Phone:607-739-0352
Practice Address - Fax:607-739-6909
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022135363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY022135OtherNYS LICENSE