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General NPI Number Information
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NPI Number | 1467543298
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Entity Type | Individual
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Provider Name | SUSAN MARIE NOLL NP
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Gender | Female
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 04/11/2016
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Provider Practice Location Address
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Address Line | 3001 EXPRESSWAY DR N 112
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City | ISLANDIA
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State | NY
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Zip | 11749-5301
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Country | US
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Telephone | 631-435-4322
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Fax | 631-435-3423
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Provider Business Mailing Address
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Address Line | 3001 EXPRESSWAY DR N 112
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City | ISLANDIA
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State | NY
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Zip | 11749-5301
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Country | US
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Telephone | 631-435-4322
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Fax | 631-435-3423
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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 | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | F360052
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License Number State | NY
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