Provider Demographics
NPI:1083219604
Name:NOLAN, MEGHAN (LAC)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:NOLAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 SE 14TH AVE APT 110
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3658
Mailing Address - Country:US
Mailing Address - Phone:203-913-2829
Mailing Address - Fax:
Practice Address - Street 1:3880 SE BROOKLYN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1674
Practice Address - Country:US
Practice Address - Phone:503-236-2389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist