Basic Information
| Provider Information | |||||||||
| NPI: | 1447698998 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOLEN | ||||||||
| FirstName: | KATIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44250 DEQUINDRE RD | ||||||||
| Address2: | |||||||||
| City: | STERLING HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483141002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489640400 | ||||||||
| FaxNumber: | 2489640401 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 S WASHINGTON ST STE A | ||||||||
| Address2: | |||||||||
| City: | OXFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483714978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482368549 | ||||||||
| FaxNumber: | 2482368599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2013 | ||||||||
| LastUpdateDate: | 07/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5101020381 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.