Healthcare Provider Details

I. General information

NPI: 1659371318
Provider Name (Legal Business Name): YVONNE FERNANDEZ NOBLES PSY D., L.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 03/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 SAINT PETER ST SUITE 429
SAINT PAUL MN
55102-1130
US

IV. Provider business mailing address

408 SAINT PETER ST SUITE D2
SAINT PAUL MN
55102-1130
US

V. Phone/Fax

Practice location:
  • Phone: 651-224-0614
  • Fax: 651-224-5754
Mailing address:
  • Phone: 651-224-0614
  • Fax: 651-224-5754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP 4435
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: