Provider Demographics
NPI:1295979961
Name:NOEL, JACQULINE (CNA)
Entity type:Individual
Prefix:
First Name:JACQULINE
Middle Name:
Last Name:NOEL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7305 CHILTON LN
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-1409
Mailing Address - Country:US
Mailing Address - Phone:770-996-2577
Mailing Address - Fax:
Practice Address - Street 1:7305 CHILTON LN
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-1409
Practice Address - Country:US
Practice Address - Phone:770-996-2577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0000006154376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide