Provider Demographics
NPI:1366940702
Name:NOEL, AMELIE JANE
Entity type:Individual
Prefix:
First Name:AMELIE
Middle Name:JANE
Last Name:NOEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11920 FARGO RD NE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OR
Mailing Address - Zip Code:97002-8686
Mailing Address - Country:US
Mailing Address - Phone:503-758-3194
Mailing Address - Fax:
Practice Address - Street 1:4235 WHEAT CT NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-2388
Practice Address - Country:US
Practice Address - Phone:503-758-3194
Practice Address - Fax:503-776-9048
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200830346LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse