Provider Demographics
NPI:1679357362
Name:NOONAN, VENTRELLE
Entity Type:Individual
Prefix:
First Name:VENTRELLE
Middle Name:
Last Name:NOONAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 EDGEWOOD DR APT E3
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-1039
Mailing Address - Country:US
Mailing Address - Phone:419-203-4770
Mailing Address - Fax:
Practice Address - Street 1:1475 EDGEWOOD DR APT E3
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-1039
Practice Address - Country:US
Practice Address - Phone:419-203-4770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi