=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114653847
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY MARIE NOONAN MSN, APRN, FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2022
-----------------------------------------------------
Last Update Date | 07/26/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 534 SCHOOL ST
-----------------------------------------------------
City | WEBSTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01570-4319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-943-0612
-----------------------------------------------------
Fax | 508-943-5855
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 34 PEARLY LN
-----------------------------------------------------
City | GARDNER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01440-1736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-943-0612
-----------------------------------------------------
Fax | 508-943-5855
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 192981
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------