Provider Demographics
NPI:1689464174
Name:NOONEN, RICKEY RONALD
Entity type:Individual
Prefix:
First Name:RICKEY
Middle Name:RONALD
Last Name:NOONEN
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 1:16510 CINNAMON DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-1440
Mailing Address - Country:US
Mailing Address - Phone:402-616-3114
Mailing Address - Fax:
Practice Address - Street 1:16510 CINNAMON DR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68136-1440
Practice Address - Country:US
Practice Address - Phone:402-616-3114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant