Individual
JILL A NOACK
Active
Individual
JILL A NOACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
5601001749
MI
363AM0700X
Medical Physician Assistant
Primary
5601001749
MI
363AS0400X
Surgical Physician Assistant
5601001749
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0C91143
BCBSM
MI
01
—
CA3050
RAILROAD MEDICARE
MI
Enumeration date
08/31/2005
Last updated
01/12/2011
Update your record
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