Provider Demographics
NPI:1275715120
Name:NOONAN, ROBERT BRIAN (ARNP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRIAN
Last Name:NOONAN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3857 MARTIN WAY E
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5268
Mailing Address - Country:US
Mailing Address - Phone:360-704-7170
Mailing Address - Fax:360-709-4374
Practice Address - Street 1:4422 6TH AVE SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1020
Practice Address - Country:US
Practice Address - Phone:360-704-7170
Practice Address - Fax:360-709-4374
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007939163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA001053300Medicare Oscar/Certification