Provider Demographics
NPI:1770575813
Name:NOECKER, ROBERT ELLIS (CRNA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ELLIS
Last Name:NOECKER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-2902
Mailing Address - Country:US
Mailing Address - Phone:610-360-6975
Mailing Address - Fax:610-841-4433
Practice Address - Street 1:3147 COLLEGE HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4813
Practice Address - Country:US
Practice Address - Phone:610-841-2432
Practice Address - Fax:610-841-4433
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN206769L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
753047838002OtherTRICARE
N0566906OtherHIGHMARK
PAP00223408OtherRAILROAD MEDICARE
PAP00205446OtherRAILROAD MEDICARE
PA20038940OtherAMERIHEALTH MERCY
N0566906OtherHIGHMARK
R07413Medicare UPIN
PAP00223408OtherRAILROAD MEDICARE