Provider Demographics
NPI:1063048320
Name:NOEL, RODNEY MICHEAL
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:MICHEAL
Last Name:NOEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RODNEY
Other - Middle Name:MICHEAL
Other - Last Name:NOEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:150 NORTH AVE APT 302A
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-1970
Mailing Address - Country:US
Mailing Address - Phone:330-622-3547
Mailing Address - Fax:
Practice Address - Street 1:150 NORTH AVE APT 302A
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1970
Practice Address - Country:US
Practice Address - Phone:330-622-3547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2858831374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2858831Medicaid