Provider Demographics
NPI:1730261306
Name:NOONE, SUZANNE PECK (NP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:PECK
Last Name:NOONE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 GROVE ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-3156
Mailing Address - Country:US
Mailing Address - Phone:508-528-5392
Mailing Address - Fax:508-541-2420
Practice Address - Street 1:94 MENDON ST
Practice Address - Street 2:
Practice Address - City:HOPEDALE
Practice Address - State:MA
Practice Address - Zip Code:01747-1311
Practice Address - Country:US
Practice Address - Phone:508-482-5401
Practice Address - Fax:508-482-5402
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA124212363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP2417OtherBLUE CROSS BLUE SHIELD
MA55350OtherFALLON
MANP2417OtherBLUE CROSS BLUE SHIELD
NP2417Medicare ID - Type Unspecified