Provider Demographics
NPI:1831349174
Name:NOEL, GINA (LMP)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:NOEL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 AVENUE D
Mailing Address - Street 2:SUITE D207
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-0000
Mailing Address - Country:US
Mailing Address - Phone:360-563-0209
Mailing Address - Fax:360-563-0243
Practice Address - Street 1:1101 AVENUE D
Practice Address - Street 2:SUITE D207
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-0000
Practice Address - Country:US
Practice Address - Phone:360-563-0209
Practice Address - Fax:360-563-0243
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60036403225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist