Provider Demographics
NPI:1083657142
Name:NOONAN, LAURIE H (CRNA)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:H
Last Name:NOONAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 N. MAPLE RD.
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9208
Mailing Address - Country:US
Mailing Address - Phone:734-996-4525
Mailing Address - Fax:248-357-0915
Practice Address - Street 1:4615 N MAPLE RD.
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9208
Practice Address - Country:US
Practice Address - Phone:734-996-4525
Practice Address - Fax:248-357-0915
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704106220367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MILN106220OtherBLUE CROSS NUMBER
MILN106220OtherBLUE CROSS NUMBER