Provider Demographics
NPI:1558661538
Name:NOLAN, WHITNEY L (PA-C)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:L
Last Name:NOLAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:L
Other - Last Name:HUSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1600 PENINSULA DR STE 9
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4261
Mailing Address - Country:US
Mailing Address - Phone:814-877-7035
Mailing Address - Fax:814-877-6276
Practice Address - Street 1:1600 PENINSULA DR STE 9
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4261
Practice Address - Country:US
Practice Address - Phone:814-877-7035
Practice Address - Fax:814-877-6276
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054642363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant