Provider Demographics
NPI:1871326264
Name:RICH, NOEL A
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:A
Last Name:RICH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10220 PRAIRIE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53158-1946
Mailing Address - Country:US
Mailing Address - Phone:262-395-9927
Mailing Address - Fax:
Practice Address - Street 1:8525 37TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-2500
Practice Address - Country:US
Practice Address - Phone:262-395-9927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.506226163W00000X
WI245539-30163W00000X
IL209030988363LF0000X
WI15856-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily