Provider Demographics
NPI:1235811621
Name:NOLAN, ADELLE GRACE (CPT)
Entity Type:Individual
Prefix:
First Name:ADELLE
Middle Name:GRACE
Last Name:NOLAN
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19128 112TH AVE NE APT 620
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-0024
Mailing Address - Country:US
Mailing Address - Phone:425-677-4432
Mailing Address - Fax:
Practice Address - Street 1:19128 112TH AVE NE APT 620
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-0024
Practice Address - Country:US
Practice Address - Phone:425-677-4432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy