Healthcare Provider Details

I. General information

NPI: 1285638635
Provider Name (Legal Business Name): CLARISSE E NOEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N 5TH AVE STE 101
SEQUIM WA
98382-3045
US

IV. Provider business mailing address

800 N 5TH AVE STE 101
SEQUIM WA
98382-3045
US

V. Phone/Fax

Practice location:
  • Phone: 360-582-2690
  • Fax: 360-582-2691
Mailing address:
  • Phone: 360-582-2690
  • Fax: 360-582-2691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00041353
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: