Provider Demographics
NPI:1336320217
Name:NOLAN, LEONA JOYCE (LIC AC)
Entity Type:Individual
Prefix:
First Name:LEONA JOYCE
Middle Name:
Last Name:NOLAN
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 ELLIOTT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982-2206
Mailing Address - Country:US
Mailing Address - Phone:978-468-3111
Mailing Address - Fax:
Practice Address - Street 1:24 ELLIOTT ST
Practice Address - Street 2:
Practice Address - City:SOUTH HAMILTON
Practice Address - State:MA
Practice Address - Zip Code:01982-2206
Practice Address - Country:US
Practice Address - Phone:978-468-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216060171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist