Healthcare Provider Details

I. General information

NPI: 1487731782
Provider Name (Legal Business Name): PATRICIA E NOONAN CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10950 W CAPITOL DR
WAUWATOSA WI
53222-1110
US

IV. Provider business mailing address

4425 N PORT WASHINGTON RD ATTN: CSMCP CLINIC CREDENTIALING
GLENDALE WI
53212-1082
US

V. Phone/Fax

Practice location:
  • Phone: 414-464-4460
  • Fax: 414-464-7074
Mailing address:
  • Phone: 414-464-4460
  • Fax: 414-464-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number1140
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: