Basic Information
| Provider Information | |||||||||
| NPI: | 1114064235 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOLAN | ||||||||
| FirstName: | ROSEANNE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 760 MAIN ST | ||||||||
| Address2: | APT B | ||||||||
| City: | SIMPSON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708765900 | ||||||||
| FaxNumber: | 5708765300 | ||||||||
| Practice Location | |||||||||
| Address1: | 681 SCRANTON CARBONDALE HWY | ||||||||
| Address2: | |||||||||
| City: | EYNON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708765900 | ||||||||
| FaxNumber: | 5708765300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA052188 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.