Provider Demographics
NPI:1366908824
Name:NOBILITY WELLNESS SERVICES, PLLC
Entity type:Organization
Organization Name:NOBILITY WELLNESS SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARREON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-317-9349
Mailing Address - Street 1:1609 BOARDWALK
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1235
Mailing Address - Country:US
Mailing Address - Phone:507-317-9349
Mailing Address - Fax:
Practice Address - Street 1:1061 GRAND AVE FL 2
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3002
Practice Address - Country:US
Practice Address - Phone:507-317-9349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty