Basic Information
| Provider Information | |||||||||
| NPI: | 1558026443 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NOBLE MISSIONS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13518 114TH AVE E | ||||||||
| Address2: | |||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983745536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707570161 | ||||||||
| FaxNumber: | 2534663537 | ||||||||
| Practice Location | |||||||||
| Address1: | 13518 114TH AVE E | ||||||||
| Address2: | |||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983745536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707570161 | ||||||||
| FaxNumber: | 2534663537 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2021 | ||||||||
| LastUpdateDate: | 11/04/2021 | ||||||||
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| AuthorizedOfficialLastName: | CHEGE | ||||||||
| AuthorizedOfficialFirstName: | LUCY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | NURSE PRACTITIONER/REGISTERED NURSE | ||||||||
| AuthorizedOfficialTelephone: | 7707570161 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DNP FNP RN | ||||||||
| NPICertificationDate: | 11/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse |
No ID Information.