Healthcare Provider Details

I. General information

NPI: 1609967207
Provider Name (Legal Business Name): NOELLE ANNE WESTRUM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NOELLE ANNE NIELSEN MD

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 E 2ND ST
DULUTH MN
55805
US

IV. Provider business mailing address

1012 E 2ND ST
DULUTH MN
55805-2200
US

V. Phone/Fax

Practice location:
  • Phone: 218-249-7870
  • Fax: 218-249-7801
Mailing address:
  • Phone: 218-249-7870
  • Fax: 218-249-7801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberTD979
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM7208
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number51308
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00042543
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18874
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: