MEDICARE: KATHLEEN A NOLL

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	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	56611	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C002035	OTHER	CO	KAISER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1578606026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN A NOLL

Provider Business Mailing Address
First Line	:	5498 S IRIS ST
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80123-7416
Country	:	US
Telephone Number	:	303-972-9679
Fax Number	:

Provider Business Practice Location Address
First Line	:	10065 E HARVARD AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-5968
Country	:	US
Telephone Number	:	303-614-1024
Fax Number	:	303-614-1025

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	11/08/2007

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Directions to “ KATHLEEN A NOLL ” Practice Location

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