Provider Demographics
NPI:1568799021
Name:NOONE, THERESA A (CNM)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:NOONE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 VINEYARD WAY
Mailing Address - Street 2:
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-8849
Mailing Address - Country:US
Mailing Address - Phone:610-444-7550
Mailing Address - Fax:610-444-4656
Practice Address - Street 1:105 VINEYARD WAY
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390
Practice Address - Country:US
Practice Address - Phone:610-444-7550
Practice Address - Fax:610-444-4656
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELK-0000152367A00000X
PAMW010308367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102894218Medicaid