=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326597246
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NOEL TRUSAL CRNP, MSN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2016
-----------------------------------------------------
Last Update Date | 07/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 MEADOWVIEW DR
-----------------------------------------------------
City | SELINSGROVE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17870-8613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-765-2954
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 284 EXECUTIVE PARK DR STE 100
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28025-1833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-939-1100
-----------------------------------------------------
Fax | 704-939-1173
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171000000X
-----------------------------------------------------
Taxonomy Name | Military Health Care Provider
-----------------------------------------------------
License Number | TP006440B
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 5018360
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | TP006440B
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------