Provider Demographics
NPI:1477592137
Name:NOLAN, THOMAS P (CRNA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:NOLAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20940 BRADFORD DR
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-1470
Mailing Address - Country:US
Mailing Address - Phone:815-469-1187
Mailing Address - Fax:
Practice Address - Street 1:20940 BRADFORD DR
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-1470
Practice Address - Country:US
Practice Address - Phone:815-469-1187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28124135367500000X
IL209-001102367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered