Provider Demographics
NPI:1982236824
Name:SMITH, NOAH
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 5TH ST SW
Mailing Address - Street 2:
Mailing Address - City:FARLEY
Mailing Address - State:IA
Mailing Address - Zip Code:52046-9527
Mailing Address - Country:US
Mailing Address - Phone:563-258-2520
Mailing Address - Fax:
Practice Address - Street 1:1450 ALTA VISTA ST
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-4327
Practice Address - Country:US
Practice Address - Phone:563-258-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-09
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer