Healthcare Provider Details

I. General information

NPI: 1992455836
Provider Name (Legal Business Name): NOBILITY DISTRIBUTORS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 04/26/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 BRADLEY PLACE, ANIGUA
AGANA GU
96913
US

IV. Provider business mailing address

121 BRADLEY PLACE ANIGUA
AGANA GU
96910
US

V. Phone/Fax

Practice location:
  • Phone: 671-489-8463
  • Fax:
Mailing address:
  • Phone: 671-489-8463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. DAYRIEL A OLLET
Title or Position: GENERAL MANAGER
Credential:
Phone: 671-489-8463