Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | R053391 | MD |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | R053391 | MD |
NPI | 1013372705 |
---|---|
Provider Name | Constance Noll |
First Address | Havre De Grace, MD 21078-3409 |
Second Address | Havre De Grace, MD 21078-3409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2015 |
Last Update Date | 18/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
673000100 | (05) | MD |