Provider Demographics
NPI:1306434170
Name:MOONEY, NOEL (RN)
Entity type:Individual
Prefix:MR
First Name:NOEL
Middle Name:
Last Name:MOONEY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 HERITAGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-1816
Mailing Address - Country:US
Mailing Address - Phone:617-982-9724
Mailing Address - Fax:
Practice Address - Street 1:40 HERITAGE HILL RD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-1816
Practice Address - Country:US
Practice Address - Phone:617-982-9724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233649163WG0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice