Individual
TODD NOACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
222 12TH ST, DE WITT, IA 52742-1116
(563) 726-3244
Mailing address
414 6TH ST, DE WITT, IA 52742-1722
(563) 726-3244
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
PR16012
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
82-0730805
—
IA
Enumeration date
02/07/2018
Last updated
06/11/2019
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