Provider Demographics
NPI:1437961737
Name:MILLSAP HARRIMAN, NOELLE DIANE
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:DIANE
Last Name:MILLSAP HARRIMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42671 SANDY BAY RD
Mailing Address - Street 2:
Mailing Address - City:BERMUDA DUNES
Mailing Address - State:CA
Mailing Address - Zip Code:92203-1355
Mailing Address - Country:US
Mailing Address - Phone:360-606-4907
Mailing Address - Fax:
Practice Address - Street 1:42671 SANDY BAY RD
Practice Address - Street 2:
Practice Address - City:BERMUDA DUNES
Practice Address - State:CA
Practice Address - Zip Code:92203-1355
Practice Address - Country:US
Practice Address - Phone:360-606-4907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376G00000XNursing Service Related ProvidersNursing Home Administrator