Provider Demographics
NPI:1912300369
Name:KAMAL, NOEL N (APN)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:N
Last Name:KAMAL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:NOEL
Other - Middle Name:N
Other - Last Name:NORUP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:5668 E STATE ST STE 1000
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2464
Mailing Address - Country:US
Mailing Address - Phone:815-229-7580
Mailing Address - Fax:815-229-7585
Practice Address - Street 1:5668 E STATE ST STE 1000
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2464
Practice Address - Country:US
Practice Address - Phone:815-229-7580
Practice Address - Fax:815-229-7585
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-1361221163W00000X
IL209012286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041-1361221OtherRN LICENSE