Provider Demographics
NPI:1811568934
Name:NOELLE, JESSICA (HHP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:NOELLE
Suffix:
Gender:F
Credentials:HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 E MARION ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-4768
Mailing Address - Country:US
Mailing Address - Phone:401-323-0182
Mailing Address - Fax:
Practice Address - Street 1:936 ELIZABETH RD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-2815
Practice Address - Country:US
Practice Address - Phone:401-323-0182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
231024005
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program