Provider Demographics
NPI:1003418021
Name:NOLIN, JAMESON P
Entity Type:Individual
Prefix:MR
First Name:JAMESON
Middle Name:P
Last Name:NOLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5963 MAPLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-1646
Mailing Address - Country:US
Mailing Address - Phone:216-832-0669
Mailing Address - Fax:
Practice Address - Street 1:5963 MAPLEWOOD RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-1646
Practice Address - Country:US
Practice Address - Phone:216-832-0669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0204441Medicaid