=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235214495
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELLA M NOEL DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2006
-----------------------------------------------------
Last Update Date | 04/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 157 WEST BROOKE LANE
-----------------------------------------------------
City | BLISSFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-486-2411
-----------------------------------------------------
Fax | 517-486-3967
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 157 W BROOKE LN P.O. BOX 146
-----------------------------------------------------
City | BLISSFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49228-8601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-486-2411
-----------------------------------------------------
Fax | 517-486-3967
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 5101010222
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------