Individual
JESSIKAY NOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
683 STATE AVE STE B, DICKINSON, ND 58601-4660
(701) 483-9400
Mailing address
683 STATE AVE STE B, DICKINSON, ND 58601-4660
(701) 483-9400
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
0847
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12229
BLUE CROSS AND BLUE SHIELD
ND
05
—
52114
—
ND
Enumeration date
04/01/2009
Last updated
04/01/2009
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