Provider Demographics
NPI:1669755005
Name:NOGGLE, JEREMIAH M (CNP)
Entity type:Individual
Prefix:MR
First Name:JEREMIAH
Middle Name:M
Last Name:NOGGLE
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:315 STRUTHERS LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:OH
Mailing Address - Zip Code:44405-1973
Mailing Address - Country:US
Mailing Address - Phone:330-750-1333
Mailing Address - Fax:330-750-0203
Practice Address - Street 1:315 STRUTHERS LIBERTY RD
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:OH
Practice Address - Zip Code:44405-1973
Practice Address - Country:US
Practice Address - Phone:330-750-1333
Practice Address - Fax:330-750-0203
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.12575-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily