Provider Demographics
NPI:1649246786
Name:NOEL, PHILLIP J (CRNA)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:J
Last Name:NOEL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 FOX DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22603-8613
Mailing Address - Country:US
Mailing Address - Phone:540-662-8336
Mailing Address - Fax:540-662-8593
Practice Address - Street 1:1840 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2808
Practice Address - Country:US
Practice Address - Phone:540-536-8000
Practice Address - Fax:540-536-7681
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024071648367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2603003000Medicaid
VAP00292860Medicare PIN
VAP35734Medicare UPIN
WV2603003000Medicaid