Provider Demographics
NPI:1386234326
Name:MISLANG, NOEL EMMANUEL (NP)
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:EMMANUEL
Last Name:MISLANG
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36539 GERANIUM DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532-2656
Mailing Address - Country:US
Mailing Address - Phone:714-732-6271
Mailing Address - Fax:
Practice Address - Street 1:491 E ALESSANDRO BLVD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-6071
Practice Address - Country:US
Practice Address - Phone:951-780-1835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-23
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015902363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily