Provider Demographics
NPI:1831323377
Name:NOLAN, THERESA (LPN)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:
Last Name:NOLAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4916
Mailing Address - Country:US
Mailing Address - Phone:516-223-3003
Mailing Address - Fax:516-223-3003
Practice Address - Street 1:1071 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-4916
Practice Address - Country:US
Practice Address - Phone:516-223-3003
Practice Address - Fax:516-223-3003
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087202-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse