Provider Demographics
NPI:1881675031
Name:NOLFF, DUANE R (PA-C)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:R
Last Name:NOLFF
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 W MITCHELL ST
Mailing Address - Street 2:SUITE 505
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2275
Mailing Address - Country:US
Mailing Address - Phone:231-487-2100
Mailing Address - Fax:231-487-6049
Practice Address - Street 1:560 W MITCHELL ST
Practice Address - Street 2:SUITE 505
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2275
Practice Address - Country:US
Practice Address - Phone:231-487-2100
Practice Address - Fax:231-487-6049
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003481363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1982921Medicaid
MIP754953Medicare UPIN
MI1982921Medicaid
0P6199010Medicare PIN