Provider Demographics
NPI:1619263662
Name:NOLAN, MICHELLE THERESA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:THERESA
Last Name:NOLAN
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:915 BENRIS AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQ
Mailing Address - State:NY
Mailing Address - Zip Code:11010-2434
Mailing Address - Country:US
Mailing Address - Phone:516-382-5356
Mailing Address - Fax:
Practice Address - Street 1:903 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQ
Practice Address - State:NY
Practice Address - Zip Code:11010-2208
Practice Address - Country:US
Practice Address - Phone:516-382-5356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical