MEDICARE: ALICIA NOONAN NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	71002612A	IN
2	363LF0000X	Family Nurse Practitioner	71002612A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881862415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA NOONAN NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	8558 BROADWAY
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-7032
Country	:	US
Telephone Number	:	219-392-7084
Fax Number	:	219-703-6854

Provider Business Practice Location Address
First Line	:	7651 HARVEST DR
Second Line	:
City	:	SCHERERVILLE
State	:	IN
Zip	:	46375-3476
Country	:	US
Telephone Number	:	219-322-5723
Fax Number	:	219-440-5227

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2008
Last Update Date	:	03/04/2021

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