Individual
JANE NOONAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NNP
Contact information
Practice address
2500 NE NEFF RD, BEND, OR 97701-6015
(541) 382-4321
Mailing address
PO BOX 6095, BEND, OR 97708-6095
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
202101744NP-PP
OR
363LN0000X
Neonatal Nurse Practitioner
Primary
392
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MDG798
MEDICAID MD GROUP #
AK
05
—
NP0392
—
AK
Enumeration date
08/23/2006
Last updated
07/27/2022
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