=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477590677
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NOELLE L HACKNEY CRNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2006
-----------------------------------------------------
Last Update Date | 12/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1781 METROMEDICAL DR
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28304-3862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-323-1647
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1300 CONCORD TER STE 420
-----------------------------------------------------
City | SUNRISE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33323-2899
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-945-3000
-----------------------------------------------------
Fax | 704-248-5537
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 2119
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------