Provider Demographics
NPI:1881894152
Name:NOISY HAWK, LYNELLE NANCY (MD)
Entity type:Individual
Prefix:DR
First Name:LYNELLE
Middle Name:NANCY
Last Name:NOISY HAWK
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 1:6944 N MADISON CIRCLE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642
Mailing Address - Country:US
Mailing Address - Phone:406-679-3276
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 2429
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-8486
Practice Address - Country:US
Practice Address - Phone:360-353-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND10410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND8HH611Medicare PIN
NDN721448Medicare PIN
SD8HH613Medicare PIN
ND8HH612Medicare PIN