Provider Demographics
NPI:1851153290
Name:NOBLE-HENDEN, DOMINIC ANTHONY
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:ANTHONY
Last Name:NOBLE-HENDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 7TH ST NW
Mailing Address - Street 2:
Mailing Address - City:KASSON
Mailing Address - State:MN
Mailing Address - Zip Code:55944-1064
Mailing Address - Country:US
Mailing Address - Phone:507-358-8985
Mailing Address - Fax:
Practice Address - Street 1:804 7TH ST NW
Practice Address - Street 2:
Practice Address - City:KASSON
Practice Address - State:MN
Practice Address - Zip Code:55944-1064
Practice Address - Country:US
Practice Address - Phone:507-358-8985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer