Provider Demographics
NPI:1265437537
Name:NOLAN, DORIS JANE (NP)
Entity type:Individual
Prefix:MS
First Name:DORIS
Middle Name:JANE
Last Name:NOLAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WINDSOR GATE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1061
Mailing Address - Country:US
Mailing Address - Phone:516-233-2917
Mailing Address - Fax:516-570-6457
Practice Address - Street 1:40 WINDSOR GATE DR
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:NY
Practice Address - Zip Code:11040-1061
Practice Address - Country:US
Practice Address - Phone:516-233-2917
Practice Address - Fax:516-570-6457
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2008-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304101363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1068G1Medicare ID - Type Unspecified
NYQ42738Medicare UPIN