Provider Demographics
NPI:1174603351
Name:NOLL, JOHN THOMAS (NP/CNS)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:THOMAS
Last Name:NOLL
Suffix:
Gender:M
Credentials:NP/CNS
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:THOMAS
Other - Last Name:NOLL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP/CNS
Mailing Address - Street 1:702 EAST WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:INDINANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-0000
Mailing Address - Country:US
Mailing Address - Phone:317-266-0882
Mailing Address - Fax:317-266-0889
Practice Address - Street 1:1481 W 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2803
Practice Address - Country:US
Practice Address - Phone:317-554-0000
Practice Address - Fax:317-554-0252
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN70000053A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health