Provider Demographics
NPI:1578564597
Name:NOLAN, HEIDI W (PA-C)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:W
Last Name:NOLAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1106
Mailing Address - Country:US
Mailing Address - Phone:203-688-8200
Mailing Address - Fax:203-688-8204
Practice Address - Street 1:874 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1106
Practice Address - Country:US
Practice Address - Phone:203-688-8200
Practice Address - Fax:203-688-8204
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000279363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT970013793OtherRAIL ROAD MEDICARE
CT061561581OtherUNITED HEALTHCARE
CT008037010Medicaid
CT279001OtherCONNECTICARE
CTP2364340OtherOXFORD
CT290000279CT03OtherANTHEM BC/BS
CT0Q2938OtherHEALTH NET
CT368792OtherWELLCARE OF CT
CT0Q2938OtherHEALTH NET