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General NPI Number Information
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NPI Number | 1487745253
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Entity Type | Individual
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Provider Name | PHYLLIS NOSS M.D.
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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 | 07/21/2022
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Provider Practice Location Address
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Address Line | 1924 DUNEDIN AVE
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City | DULUTH
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State | MN
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Zip | 55803-2400
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Country | US
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Telephone | 218-724-6083
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 E 25TH ST
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City | HIBBING
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State | MN
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Zip | 55746-3897
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Country | US
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Telephone | 218-312-3002
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Fax | 218-263-8933
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MN44231
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 44321
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License Number State | MN
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