Healthcare Provider Details

I. General information

NPI: 1710386123
Provider Name (Legal Business Name): TRUDY ALYCE NOON ADULT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15640 NE FOURTH PLAIN BLVD STE 106
VANCOUVER WA
98682-5141
US

IV. Provider business mailing address

15640 NE FOURTH PLAIN BLVD STE 106
VANCOUVER WA
98682-5141
US

V. Phone/Fax

Practice location:
  • Phone: 541-287-4918
  • Fax: 541-417-4269
Mailing address:
  • Phone: 541-287-4918
  • Fax: 541-417-4269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60708435
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60708435
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number201502243NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: