Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 54803 | ID |
NPI | 1003355298 |
---|---|
Provider Name | Noelle Marie Beierle |
First Address | Coeur D Alene, ID 83814-2668 |
Second Address | Coeur D'alene, ID 83814-2668 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2017 |
Last Update Date | 03/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003355298 | (05) | ID |