MEDICARE: NOEL NEEDHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	201141210RN	OR

General Provider Information

NPI Number	:	1154257277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOEL NEEDHAM

Provider Business Mailing Address
First Line	:	1710 NE BEVERLY DR
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-3519
Country	:	US
Telephone Number	:	702-332-2397
Fax Number	:

Provider Business Practice Location Address
First Line	:	1710 NE BEVERLY DR
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-3519
Country	:	US
Telephone Number	:	702-332-2397
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2026
Last Update Date	:	06/18/2026

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Directions to “ NOEL NEEDHAM ” Practice Location

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