Provider Demographics
NPI:1306547161
Name:KOLLER-DITTO, NOEL (DNP, AGCNS-BC)
Entity type:Individual
Prefix:MRS
First Name:NOEL
Middle Name:
Last Name:KOLLER-DITTO
Suffix:
Gender:F
Credentials:DNP, AGCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10289 BELLE MDW
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-8737
Mailing Address - Country:US
Mailing Address - Phone:734-643-2244
Mailing Address - Fax:
Practice Address - Street 1:10289 BELLE MDW
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-8737
Practice Address - Country:US
Practice Address - Phone:734-643-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704281934364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist