Provider Demographics
NPI:1114653847
Name:NOONAN, NANCY MARIE (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:MARIE
Last Name:NOONAN
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 PEARLY LN
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-1736
Mailing Address - Country:US
Mailing Address - Phone:508-943-0612
Mailing Address - Fax:508-943-5855
Practice Address - Street 1:534 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570-4319
Practice Address - Country:US
Practice Address - Phone:508-943-0612
Practice Address - Fax:508-943-5855
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA192981363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPENDINGMedicaid