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General NPI Number Information
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NPI Number | 1619701620
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Entity Type | Individual
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Provider Name | NOELLE NISCO
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Gender | Female
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Dates
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Enumeration Date | 08/30/2024
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 475 ATLANTIC AVE STE 2
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City | BROOKLYN
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State | NY
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Zip | 11217-4383
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Country | US
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Telephone | 917-246-7498
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Fax |
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Provider Business Mailing Address
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Address Line | 6255 W SUNSET BLVD FL 21
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City | LOS ANGELES
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State | CA
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Zip | 90028-7422
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Country | US
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Telephone | 323-860-5200
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 954558
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95381021
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN323785
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 356143
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License Number State | NY
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