Healthcare Provider Details

I. General information

NPI: 1528115722
Provider Name (Legal Business Name): NOEL M. JARVIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 DERONDA ST
AMERY WI
54001-1412
US

IV. Provider business mailing address

265 GRIFFIN ST. EAST
AMERY WI
54001-1439
US

V. Phone/Fax

Practice location:
  • Phone: 715-268-0060
  • Fax: 715-268-0061
Mailing address:
  • Phone: 715-268-8000
  • Fax: 715-268-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD24856
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number54707-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: