Provider Demographics
NPI:1285986216
Name:NOONAN, KATHLEEN (RN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:NOONAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11689 TESLA ROAD
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550
Mailing Address - Country:US
Mailing Address - Phone:925-423-8999
Mailing Address - Fax:
Practice Address - Street 1:11689 TESLA ROAD
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550
Practice Address - Country:US
Practice Address - Phone:925-423-8999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA309404163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse