Provider Demographics
NPI:1114064235
Name:NOLAN, ROSEANNE E (PAC)
Entity Type:Individual
Prefix:MS
First Name:ROSEANNE
Middle Name:E
Last Name:NOLAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 MAIN ST
Mailing Address - Street 2:APT B
Mailing Address - City:SIMPSON
Mailing Address - State:PA
Mailing Address - Zip Code:18407
Mailing Address - Country:US
Mailing Address - Phone:570-876-5900
Mailing Address - Fax:570-876-5300
Practice Address - Street 1:681 SCRANTON CARBONDALE HWY
Practice Address - Street 2:
Practice Address - City:EYNON
Practice Address - State:PA
Practice Address - Zip Code:18403
Practice Address - Country:US
Practice Address - Phone:570-876-5900
Practice Address - Fax:570-876-5300
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052188363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant