Healthcare Provider Details

I. General information

NPI: 1588570543
Provider Name (Legal Business Name): ANNALISE VICTORIA NOBLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5067 N ACADEMY BLVD
COLORADO SPRINGS CO
80918-4125
US

IV. Provider business mailing address

6315 NORTHWIND DR
COLORADO SPRINGS CO
80918-4863
US

V. Phone/Fax

Practice location:
  • Phone: 781-742-5619
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number1164310447
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: