Provider Demographics
NPI:1871921221
Name:NOLL, MALERIE CATERINA (PA-C)
Entity type:Individual
Prefix:
First Name:MALERIE
Middle Name:CATERINA
Last Name:NOLL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MALERIE
Other - Middle Name:CATERINA
Other - Last Name:MOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:933 BRADBURY DR SE STE 2222
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4375
Mailing Address - Country:US
Mailing Address - Phone:505-272-1415
Mailing Address - Fax:505-232-1368
Practice Address - Street 1:2211 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2719
Practice Address - Country:US
Practice Address - Phone:505-925-0660
Practice Address - Fax:505-925-0680
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2013-0062363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant