Provider Demographics
NPI:1992841639
Name:NOOREN, CARA LEA (RN, CNS, FNP)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:LEA
Last Name:NOOREN
Suffix:
Gender:F
Credentials:RN, CNS, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 SECRET RAVINE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-6041
Mailing Address - Country:US
Mailing Address - Phone:916-782-8130
Mailing Address - Fax:916-782-8160
Practice Address - Street 1:1411 SECRET RAVINE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-6041
Practice Address - Country:US
Practice Address - Phone:916-782-8130
Practice Address - Fax:916-782-8160
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA651233163W00000X
CA16308363LF0000X
CA2437364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA651233OtherREGISTERED NURSE
CA2437OtherCLINICAL NURSE SPECIALIST
CA16308OtherFAMILY NURSE PRACTITIONER