Provider Demographics
NPI:1053440057
Name:NOELLER, TANDY SUZANNE (ARNP, CNS, FNP)
Entity type:Individual
Prefix:MS
First Name:TANDY
Middle Name:SUZANNE
Last Name:NOELLER
Suffix:
Gender:F
Credentials:ARNP, CNS, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 12TH STREET
Mailing Address - Street 2:
Mailing Address - City:SEVERY
Mailing Address - State:KS
Mailing Address - Zip Code:67137-0093
Mailing Address - Country:US
Mailing Address - Phone:620-736-2639
Mailing Address - Fax:620-736-2639
Practice Address - Street 1:2045 12TH STREET
Practice Address - Street 2:
Practice Address - City:SEVERY
Practice Address - State:KS
Practice Address - Zip Code:67137-0093
Practice Address - Country:US
Practice Address - Phone:620-736-2639
Practice Address - Fax:620-736-2639
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-33753-081163W00000X, 163WC1600X, 163WC3500X, 163WD0400X, 163WE0003X, 163WW0000X
KS44916363L00000X, 363LF0000X, 363LX0106X
KS74710364S00000X, 364SF0001X, 364SH1100X, 364SM0705X, 364SX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
Not Answered163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation
Not Answered163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Not Answered163WE0003XNursing Service ProvidersRegistered NurseEmergency
Not Answered163WW0000XNursing Service ProvidersRegistered NurseWound Care
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Not Answered363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
Not Answered364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Not Answered364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Not Answered364SH1100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHolistic
Not Answered364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Not Answered364SX0106XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1548313471OtherNPI FOR BUSINESS
KS0000161786OtherBCBSKS