Provider Demographics
NPI:1568226314
Name:NOLAN, KIERSTEN SUZANNE (CNP)
Entity Type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:SUZANNE
Last Name:NOLAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2549 COLDWATER XING
Mailing Address - Street 2:
Mailing Address - City:MAYER
Mailing Address - State:MN
Mailing Address - Zip Code:55360-4534
Mailing Address - Country:US
Mailing Address - Phone:952-452-3858
Mailing Address - Fax:
Practice Address - Street 1:500 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1752
Practice Address - Country:US
Practice Address - Phone:952-442-2191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11281363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics