Healthcare Provider Details

I. General information

NPI: 1790214500
Provider Name (Legal Business Name): STEPHEN RICHARD NOORLANDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 07/21/2022
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 S PIONEER WAY
MOSES LAKE WA
98837-4613
US

IV. Provider business mailing address

660 S COOLIDGE ST
MOSES LAKE WA
98837-1872
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-4850
  • Fax: 630-978-6865
Mailing address:
  • Phone: 509-793-9715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number207Q0000OX
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61041311
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: