Provider Demographics
NPI:1962042325
Name:SERNETT, NOELLE MAREE (ATC)
Entity Type:Individual
Prefix:MS
First Name:NOELLE
Middle Name:MAREE
Last Name:SERNETT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3165 WILLOW POINTE DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-2614
Mailing Address - Country:US
Mailing Address - Phone:509-551-3082
Mailing Address - Fax:
Practice Address - Street 1:3165 WILLOW POINTE DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-2614
Practice Address - Country:US
Practice Address - Phone:509-551-3082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1.610866512255A2300X
WA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer