Provider Demographics
NPI:1114197290
Name:KIRBY-NOLAN, MISTY MICHELLE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:MICHELLE
Last Name:KIRBY-NOLAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:201 E HURON ST
Mailing Address - Street 2:GALTER PAVILION 5-142
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3197
Mailing Address - Country:US
Mailing Address - Phone:312-926-5698
Mailing Address - Fax:312-926-0860
Practice Address - Street 1:201 E HURON ST
Practice Address - Street 2:GALTER PAVILION 5-142
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-926-5698
Practice Address - Fax:312-926-0860
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL041239045163W00000X
IL209001928363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse