Provider Demographics
NPI:1669810644
Name:NOLAN, KRISTIN E (PA)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:E
Last Name:NOLAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1490 DELGANY ST APT 737
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-6610
Mailing Address - Country:US
Mailing Address - Phone:618-977-2166
Mailing Address - Fax:
Practice Address - Street 1:777 BANNOCK ST.
Practice Address - Street 2:DENVER HEALTH
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-0001
Practice Address - Country:US
Practice Address - Phone:303-602-2715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002910363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400090207Medicare PIN