Basic Information
| Provider Information | |||||||||
| NPI: | 1952953374 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NOLAND | ||||||||
| FirstName: | ANNAH | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RN, CDE | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JOHNSON | ||||||||
| OtherFirstName: | ANNAH | ||||||||
| OtherMiddleName: | ELIZABETH | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 23189 | ||||||||
| Address2: | |||||||||
| City: | BARRIGADA | ||||||||
| State: | GU | ||||||||
| PostalCode: | 969213189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6714805449 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 851 GOV CARLOS G CAMACHO RD | ||||||||
| Address2: | |||||||||
| City: | TAMUNING | ||||||||
| State: | GU | ||||||||
| PostalCode: | 969133153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6716478262 | ||||||||
| FaxNumber: | 6716489400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2019 | ||||||||
| LastUpdateDate: | 07/16/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WD0400X | RE2299 | GU | Y | Nursing Service Providers | Registered Nurse | Diabetes Educator |
No ID Information.