Provider Demographics
NPI:1245551639
Name:NOONAN, ALICIA M (NP-C)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:M
Last Name:NOONAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 PEACHVALE DR
Mailing Address - Street 2:
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382-2234
Mailing Address - Country:US
Mailing Address - Phone:860-822-5585
Mailing Address - Fax:
Practice Address - Street 1:75 EASTERN POINT RD
Practice Address - Street 2:DEPT 644 BLDG 78A
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-4905
Practice Address - Country:US
Practice Address - Phone:860-433-9390
Practice Address - Fax:860-433-7802
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-20
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT076404163W00000X
CT4387363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner