Provider Demographics
NPI:1578202420
Name:NOONAN, JESSICA NADINE (LVN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:NADINE
Last Name:NOONAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SHERIDAN AVE APT 100
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2763
Mailing Address - Country:US
Mailing Address - Phone:530-282-0374
Mailing Address - Fax:
Practice Address - Street 1:1301 SHERIDAN AVE APT 100
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2763
Practice Address - Country:US
Practice Address - Phone:530-282-0374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA724055164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse