Provider Demographics
NPI:1952351215
Name:NOLAN, JOHN (FP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:NOLAN
Suffix:
Gender:M
Credentials:FP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1 FOX CARE DR
Mailing Address - Street 2:308
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2086
Mailing Address - Country:US
Mailing Address - Phone:607-432-1163
Mailing Address - Fax:607-431-5367
Practice Address - Street 1:1 FOX CARE DR
Practice Address - Street 2:308
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2086
Practice Address - Country:US
Practice Address - Phone:607-432-1163
Practice Address - Fax:607-431-5367
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY010983363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical