Noelle Josephine Wilson, BKIN, MSCPT, DPT

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

4991 Issued in MN

Practice address

28210 Old Towne Rd
Chisago City, MN 55013-9556

Phone

(651) 257-0575

NPI assigned

Nov 14, 2022

Last updated

Nov 14, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Noelle Josephine Macdougall Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1668384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668384000000",
    "number": "1861100257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 393",
            "city": "CAMBRIDGE",
            "state": "MN",
            "postal_code": "550080393",
            "telephone_number": "780-938-5944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28210 OLD TOWNE RD",
            "city": "CHISAGO CITY",
            "state": "MN",
            "postal_code": "550139556",
            "telephone_number": "651-257-0575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "NOELLE",
        "middle_name": "JOSEPHINE",
        "credential": "BKIN, MSCPT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-14",
        "last_updated": "2022-11-14",
        "certification_date": "2022-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MN",
            "license": "4991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NOELLE",
            "last_name": "MACDOUGALL",
            "middle_name": "JOSEPHINE",
            "credential": "BKIN, MSCPT, DPT",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Physical Medicine & Rehabilitation Physician in Chisago City, MN
• Providers in Chisago City, MN by specialty
• Physical Medicine & Rehabilitation Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.