Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 4310177980 | MI |
N | 207PP0204X | Pediatric Emergency Physician | 4301077980 | MI |
NPI | 1356307482 |
---|---|
Provider Name | Stacey Katherine Noel |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48109-5000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 07/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104782648 | (05) | MI |
I43624 | (02) | MI |
P00247222 | RR MEDICARE (01) | MI |