Provider Demographics
NPI:1740597111
Name:NOEL, NATASHA DENISE (MD)
Entity type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:DENISE
Last Name:NOEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 NORTH CT
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-1224
Mailing Address - Country:US
Mailing Address - Phone:815-285-5437
Mailing Address - Fax:
Practice Address - Street 1:144 NORTH CT
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-1224
Practice Address - Country:US
Practice Address - Phone:815-285-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01093851A208000000X, 2080P0202X, 208M00000X
IL0361328122080P0202X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036132812Medicaid