Provider Demographics
NPI:1124798855
Name:NOLTE, DANIEL (PA)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:NOLTE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:110 ELM ST FL 3
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4626
Mailing Address - Country:US
Mailing Address - Phone:401-443-4992
Mailing Address - Fax:401-537-7241
Practice Address - Street 1:400 BALD HILL RD FL 2
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1617
Practice Address - Country:US
Practice Address - Phone:401-738-4323
Practice Address - Fax:401-738-3857
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RIPA01370363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant