Provider Demographics
NPI:1720716681
Name:EFANTIS, NOELLE GRACE (DNP, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:NOELLE
Middle Name:GRACE
Last Name:EFANTIS
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 BENNETT RD
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01036-9103
Mailing Address - Country:US
Mailing Address - Phone:860-709-3772
Mailing Address - Fax:
Practice Address - Street 1:1200 CONVERSE ST STE 200
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1760
Practice Address - Country:US
Practice Address - Phone:413-374-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2302800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily