MEDICARE: DR. LYNELLE NANCY NOISY HAWK MD

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	10410	ND

General Provider Information

NPI Number	:	1881894152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYNELLE NANCY NOISY HAWK MD

Provider Business Mailing Address
First Line	:	6944 N MADISON CIRCLE
Second Line	:
City	:	RIDGEFIELD
State	:	WA
Zip	:	98642
Country	:	US
Telephone Number	:	406-679-3276
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 2429
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-8486
Country	:	US
Telephone Number	:	360-353-9494
Fax Number	:

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

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	05/29/2024

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