Provider Demographics
NPI:1487731782
Name:NOONAN, PATRICIA E (CNS)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:E
Last Name:NOONAN
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 N PORT WASHINGTON RD
Mailing Address - Street 2:ATTN: CSMCP CLINIC CREDENTIALING
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1082
Mailing Address - Country:US
Mailing Address - Phone:414-464-4460
Mailing Address - Fax:414-464-7074
Practice Address - Street 1:10950 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-1110
Practice Address - Country:US
Practice Address - Phone:414-464-4460
Practice Address - Fax:414-464-7074
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1140364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41175100Medicaid
WIP97742Medicare UPIN