Basic Information
Provider Information
NPI: 1457081960
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NOBLE
FirstName: HELEN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: NOBLE
OtherFirstName: HAILEY
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 5
Mailing Information
Address1: 43 E CONCORD ST APT 2
Address2:  
City: BOSTON
State: MA
PostalCode: 021181942
CountryCode: US
TelephoneNumber: 8022805878
FaxNumber:  
Practice Location
Address1: 1 BOSTON MEDICAL CTR PL STE 1
Address2:  
City: BOSTON
State: MA
PostalCode: 021182999
CountryCode: US
TelephoneNumber: 6176388000
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/16/2022
LastUpdateDate: 06/16/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/16/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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