Provider Demographics
NPI:1699547216
Name:NOBLE, BRANDON (CPO)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:NOBLE
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HIGHLAND PARK PLZ STE 1
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7128
Mailing Address - Country:US
Mailing Address - Phone:985-898-6319
Mailing Address - Fax:
Practice Address - Street 1:101 HIGHLAND PARK PLZ STE 1
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7128
Practice Address - Country:US
Practice Address - Phone:985-898-6319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist