Provider Demographics
NPI:1780220772
Name:KRAUS, NOELLE JOY (PA)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:JOY
Last Name:KRAUS
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 1:20301 SW BIRCH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1754
Mailing Address - Country:US
Mailing Address - Phone:949-251-1502
Mailing Address - Fax:949-251-1522
Practice Address - Street 1:20301 SW BIRCH ST STE 100
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1754
Practice Address - Country:US
Practice Address - Phone:949-251-1502
Practice Address - Fax:949-251-1522
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA57526363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant