Healthcare Provider Details

I. General information

NPI: 1245551639
Provider Name (Legal Business Name): ALICIA M NOONAN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2010
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 EASTERN POINT RD DEPT 644 BLDG 78A
GROTON CT
06340-4905
US

IV. Provider business mailing address

32 PEACHVALE DR
UNCASVILLE CT
06382-2234
US

V. Phone/Fax

Practice location:
  • Phone: 860-433-9390
  • Fax: 860-433-7802
Mailing address:
  • Phone: 860-822-5585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number076404
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4387
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4387
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: