Provider Demographics
NPI:1912463415
Name:PERKOWSKI, NOELLE (RDN)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:PERKOWSKI
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42D MEDICAL GROUP, 300 S. TWINING ST. BLDG. 760
Mailing Address - Street 2:MONTGOMERY, AL
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:36112
Mailing Address - Country:US
Mailing Address - Phone:334-953-3368
Mailing Address - Fax:
Practice Address - Street 1:42D MEDICAL GROUP, 300 S. TWINING ST. BLDG. 760
Practice Address - Street 2:MONTGOMERY, AL
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:36112
Practice Address - Country:US
Practice Address - Phone:334-953-3368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-20
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2935133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered