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General NPI Number Information
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NPI Number | 1124719604
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Entity Type | Organization
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Legal Business Name | A WILLING NOBLE SERVICES LLC
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Dates
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Enumeration Date | 05/16/2023
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Last Update Date | 05/16/2023
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Provider Practice Location Address
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Address Line | 2151 SW BARTHEL ST
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34984-4301
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Country | US
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Telephone | 561-755-1797
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Fax | 480-906-1475
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Provider Business Mailing Address
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Address Line | 2151 SW BARTHEL ST
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34984-4301
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Country | US
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Telephone | 561-755-1797
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Fax | 480-906-1475
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Authorized Official
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Title or Position | APRN
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Name | MRS. KATHERINE NICOLE WILLINGHAM
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Credential | APRN
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Telephone | 561-755-1797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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Taxonomy #3
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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Taxonomy #4
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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Taxonomy #5
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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Taxonomy #6
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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