Provider Demographics
NPI:1710033444
Name:NOLAN, DAVIS E (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:DAVIS
Middle Name:E
Last Name:NOLAN
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6504 WESTBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-1882
Mailing Address - Country:US
Mailing Address - Phone:919-302-6033
Mailing Address - Fax:
Practice Address - Street 1:307 S SALEM ST STE 302
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-1845
Practice Address - Country:US
Practice Address - Phone:919-367-0677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002692133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered