Provider Demographics
NPI:1174746051
Name:NOONAN, LYLLIEN AMANDA (MED)
Entity type:Individual
Prefix:MRS
First Name:LYLLIEN
Middle Name:AMANDA
Last Name:NOONAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7504 NICHOLAS STREET
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375
Mailing Address - Country:US
Mailing Address - Phone:219-322-5865
Mailing Address - Fax:
Practice Address - Street 1:7504 NICHOLAS ST
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-3458
Practice Address - Country:US
Practice Address - Phone:219-322-5865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist