Provider Demographics
NPI:1770023319
Name:NOLAN, ANDREA (HIS)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:NOLAN
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 E MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:314 E MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7128
Practice Address - Country:US
Practice Address - Phone:302-737-0747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE03-0000230237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist