MEDICARE: DR. CLARISSE E NOEL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD00041353	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0197263	OTHER	WA	WA LABOR & INDUSTRIES

General Provider Information

NPI Number	:	1285638635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLARISSE E NOEL M.D.

Provider Business Mailing Address
First Line	:	800 N 5TH AVE
Second Line	:	STE 101
City	:	SEQUIM
State	:	WA
Zip	:	98382-3045
Country	:	US
Telephone Number	:	360-582-2690
Fax Number	:	360-582-2691

Provider Business Practice Location Address
First Line	:	800 N 5TH AVE
Second Line	:	STE 101
City	:	SEQUIM
State	:	WA
Zip	:	98382-3045
Country	:	US
Telephone Number	:	360-582-2690
Fax Number	:	360-582-2691

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/08/2007

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