Provider Demographics
NPI:1033708425
Name:BOLAN, NANCY ELIZABETH (RN, FNP, CNM, PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ELIZABETH
Last Name:BOLAN
Suffix:
Gender:F
Credentials:RN, FNP, CNM, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 PARKWAY W
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-1141
Mailing Address - Country:US
Mailing Address - Phone:202-699-2511
Mailing Address - Fax:
Practice Address - Street 1:655 W LOMBARD ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1512
Practice Address - Country:US
Practice Address - Phone:202-699-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY428602163WG0000X
NYF331022363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice