Basic Information
| Provider Information | |||||||||
| NPI: | 1407287311 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NOLAN | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | RN BSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9475 LOTTSFORD RD STE 250 | ||||||||
| Address2: | |||||||||
| City: | LARGO | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207745346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016366504 | ||||||||
| FaxNumber: | 3016366509 | ||||||||
| Practice Location | |||||||||
| Address1: | 9475 LOTTSFORD RD STE 250 | ||||||||
| Address2: | |||||||||
| City: | LARGO | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207745346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016366504 | ||||||||
| FaxNumber: | 3016366509 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2013 | ||||||||
| LastUpdateDate: | 12/02/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0809X | R086541 | MD | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult |
No ID Information.