Provider Demographics
NPI:1841776127
Name:NOLAN, LISA ANN (CRNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:NOLAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 SPRINGVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17557-9564
Mailing Address - Country:US
Mailing Address - Phone:717-354-7711
Mailing Address - Fax:
Practice Address - Street 1:584 SPRINGVILLE RD
Practice Address - Street 2:
Practice Address - City:NEW HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:17557
Practice Address - Country:US
Practice Address - Phone:717-354-4711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018775363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1841776127Medicaid