Active NPI
Noel I Vandyke
- Child Mental Illness Respite Care
- Queen Creek, AZ
National Provider Identifier
1073748463
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child Mental Illness Respite Care
- License
- 1349601
- Practice address
- 3542 E Amarillo Way
Queen Creek, AZ 85240-4320 - Phone
- (480) 888-9413
- NPI assigned
- May 28, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child Mental Illness Respite Care | 385HR2055X | 1349601 | AZ | Primary |
Addresses
Primary practice location
3542 E Amarillo Way
Queen Creek, AZ 85240-4320
Mailing address
3542 E Amarillo Way
Queen Creek, AZ 85240-4320
Phone (480) 888-9413
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1349601 | AZ | MD | Child Mental Illness Respite Care |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1243468800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1243468800000",
"number": "1073748463",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3542 E AMARILLO WAY",
"city": "QUEEN CREEK",
"state": "AZ",
"postal_code": "852404320",
"telephone_number": "480-888-9413"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3542 E AMARILLO WAY",
"city": "QUEEN CREEK",
"state": "AZ",
"postal_code": "852404320",
"telephone_number": "480-888-9413"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDYKE",
"first_name": "NOEL",
"middle_name": "I",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-05-28",
"last_updated": "2009-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "385HR2055X",
"taxonomy_group": "",
"desc": "Respite Care, Respite Care, Mental Illness, Child",
"state": "AZ",
"license": "1349601",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Queen Creek, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.