Provider Demographics
NPI:1811954183
Name:NOLEN, JOANNE ALICE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:JOANNE
Middle Name:ALICE
Last Name:NOLEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:145 NORTH COYOTE TRAIL
Mailing Address - Street 2:PO BOX 117
Mailing Address - City:ROCKVALE
Mailing Address - State:CO
Mailing Address - Zip Code:81244
Mailing Address - Country:US
Mailing Address - Phone:719-784-9684
Mailing Address - Fax:
Practice Address - Street 1:1650 COCHREN CIR
Practice Address - Street 2:USA MED DAC (ORTHODEPDIC CLINIC)
Practice Address - City:FT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913
Practice Address - Country:US
Practice Address - Phone:719-526-7176
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO526363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical