Basic Information
Provider Information | |||||||||
NPI: | 1184801672 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NOLAN | ||||||||
FirstName: | CINDY | ||||||||
MiddleName: | LOUISE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | NAUS | ||||||||
OtherFirstName: | CINDY | ||||||||
OtherMiddleName: | LOUISE | ||||||||
OtherNamePrefix: | MRS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | APN | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 42 E LAUREL RD STE 1800 | ||||||||
Address2: |   | ||||||||
City: | STRATFORD | ||||||||
State: | NJ | ||||||||
PostalCode: | 080841338 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8565666843 | ||||||||
FaxNumber: | 8565666419 | ||||||||
Practice Location | |||||||||
Address1: | 42 E LAUREL RD STE 1800 | ||||||||
Address2: |   | ||||||||
City: | STRATFORD | ||||||||
State: | NJ | ||||||||
PostalCode: | 080841338 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8565666843 | ||||||||
FaxNumber: | 8565666419 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/28/2008 | ||||||||
LastUpdateDate: | 01/04/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | UP006702B | PA | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 26NJ00162300 | NJ | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | 26NJ00162300 | 01 | NJ | TAXONTOMY | OTHER | 0288373 | 01 | NJ | MEDICAID | OTHER |