MEDICARE: JORDAN ELIZABETH NOGLE DO

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	207P00000X	Emergency Medicine Physician	2025-02319	NC
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1558003186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN ELIZABETH NOGLE DO

Provider Business Mailing Address
First Line	:	100 KIMEL FOREST DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-6074
Country	:	US
Telephone Number	:	336-716-2255
Fax Number	:

Provider Business Practice Location Address
First Line	:	DEPARTMENT OF EMERGENCY MEDICINE MEDICAL CENTER BOULEVA
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27157-0001
Country	:	US
Telephone Number	:	336-716-1902
Fax Number	:

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

Provider Enumeration Date	:	04/13/2022
Last Update Date	:	03/02/2026

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