Provider Demographics
NPI:1891815627
Name:NOE, WINTER LEIGH (MED)
Entity Type:Individual
Prefix:MRS
First Name:WINTER
Middle Name:LEIGH
Last Name:NOE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7609 CATALPA DR
Mailing Address - Street 2:
Mailing Address - City:WONDER LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60097-8689
Mailing Address - Country:US
Mailing Address - Phone:815-728-7253
Mailing Address - Fax:
Practice Address - Street 1:7609 CATALPA DR
Practice Address - Street 2:
Practice Address - City:WONDER LAKE
Practice Address - State:IL
Practice Address - Zip Code:60097-8689
Practice Address - Country:US
Practice Address - Phone:815-728-7253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILN00089279646174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist