Healthcare Provider Details

I. General information

NPI: 1639562317
Provider Name (Legal Business Name): ELIZABETH NOYES PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9030 ROUTE 108 SUITE A
COLUMBIA MD
21045-1990
US

IV. Provider business mailing address

9030 ROUTE 108 SUITE A
COLUMBIA MD
21045-1990
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-1901
  • Fax:
Mailing address:
  • Phone: 410-740-1901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR182517
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: