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General NPI Number Information
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NPI Number | 1043765134
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Entity Type | Individual
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Provider Name | NOELLE TESKE MD
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Gender | Female
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Dates
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Enumeration Date | 08/18/2016
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Last Update Date | 05/16/2024
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Provider Practice Location Address
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Address Line | 220 N 1200 E
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City | LEHI
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State | UT
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Zip | 84043-5862
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Country | US
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Telephone | 801-418-0920
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Fax | 801-418-0921
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Provider Business Mailing Address
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Address Line | 1055 N 500 W ATTN: CREDENTIALING
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City | PROVO
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State | UT
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Zip | 84604-3305
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Country | US
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Telephone | 801-354-8225
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Fax | 801-418-0941
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD200507
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 13646775-1205
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License Number State | UT
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