Individual
NOAH T SLIFE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1411 N TAYLOR DR, SHEBOYGAN, WI 53081-3043
(920) 457-4858
Mailing address
PO BOX 19070, GREEN BAY, WI 54307-9070
(920) 457-4858
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4599
WI
Other
Enumeration date
02/26/2019
Last updated
11/08/2021
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