Provider Demographics
NPI:1912154279
Name:NOBLE, MAYA W (L AC,DIPL OF AC)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:W
Last Name:NOBLE
Suffix:
Gender:F
Credentials:L AC,DIPL OF AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 E TIOGA STREET
Mailing Address - Street 2:FOUR WINDS ACUPUNCTURE CLINIC
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657
Mailing Address - Country:US
Mailing Address - Phone:570-836-7777
Mailing Address - Fax:215-550-3670
Practice Address - Street 1:134 E TIOGA STREET
Practice Address - Street 2:FOUR WINDS ACUPUNCTURE CLINIC
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657
Practice Address - Country:US
Practice Address - Phone:570-836-7777
Practice Address - Fax:215-550-3670
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000898171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAAK000898OtherNON PARTICIPATING PROVIDER