Provider Demographics
NPI:1760913883
Name:NOONE, JANIS (APN)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:
Last Name:NOONE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 GILBERT AVE
Mailing Address - Street 2:SUITE 52, 51
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1753
Mailing Address - Country:US
Mailing Address - Phone:708-387-1737
Mailing Address - Fax:708-794-8672
Practice Address - Street 1:4700 GILBERT AVE
Practice Address - Street 2:SUITE 52, 51
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1753
Practice Address - Country:US
Practice Address - Phone:708-387-1737
Practice Address - Fax:708-794-8672
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006492363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209006492Medicaid
ILPENDINGMedicare UPIN