Provider Demographics
NPI:1689848178
Name:NOONAN, ERIKA (MD)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:NOONAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N MAIN ST STE 205
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-1671
Mailing Address - Country:US
Mailing Address - Phone:435-565-1286
Mailing Address - Fax:435-800-1286
Practice Address - Street 1:150 N MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-1671
Practice Address - Country:US
Practice Address - Phone:435-565-1286
Practice Address - Fax:435-800-1286
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT73977211205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1689848178Medicaid
UTU000074307Medicare PIN