Provider Demographics
NPI:1932326543
Name:NOBLE, KENNETH REBEL (RN, DTS)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:REBEL
Last Name:NOBLE
Suffix:
Gender:M
Credentials:RN, DTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 E STATE ROAD 14
Mailing Address - Street 2:
Mailing Address - City:WINAMAC
Mailing Address - State:IN
Mailing Address - Zip Code:46996-7755
Mailing Address - Country:US
Mailing Address - Phone:574-225-1210
Mailing Address - Fax:574-946-4775
Practice Address - Street 1:840 E STATE ROAD 14
Practice Address - Street 2:
Practice Address - City:WINAMAC
Practice Address - State:IN
Practice Address - Zip Code:46996-7755
Practice Address - Country:US
Practice Address - Phone:574-225-1210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28161533A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse