Provider Demographics
NPI:1649251257
Name:NOLAN, THOMAS J (CRNA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:NOLAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009-1148
Mailing Address - Country:US
Mailing Address - Phone:207-647-6000
Mailing Address - Fax:207-647-6260
Practice Address - Street 1:25 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1167
Practice Address - Country:US
Practice Address - Phone:207-647-6000
Practice Address - Fax:207-647-6260
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAA08328367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM796801Medicare UPIN
MEMM796802Medicare PIN