Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 264353 | MA |
Y | 363L00000X | Nurse Practitioner | APRN00762 | RI |
N | 363LA2200X | Nurse Practitioner - Adult Health | APRN00762 | RI |
N | 363LG0600X | Nurse Practitioner - Gerontology | APRN00762 | RI |
N | 363LP2300X | Nurse Practitioner - Primary Care | APRN00762 | RI |
NPI | 1083085575 |
---|---|
Provider Name | Ms. Audra A Noonan |
First Address | Providence, RI 02904-5719 |
Second Address | Providence, RI 02904-5719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2015 |
Last Update Date | 29/07/2019 |