Provider Demographics
NPI:1841424322
Name:NOLAN, DONNA M (LIC AC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:NOLAN
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-3724
Mailing Address - Country:US
Mailing Address - Phone:617-479-3060
Mailing Address - Fax:
Practice Address - Street 1:44 GREENLEAF ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4411
Practice Address - Country:US
Practice Address - Phone:617-479-3060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA415171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist