Provider Demographics
NPI:1215062773
Name:NOLAN, ELLEN (APRN)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:NOLAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 WHITESIDE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS
Mailing Address - State:NC
Mailing Address - Zip Code:28741-7564
Mailing Address - Country:US
Mailing Address - Phone:307-690-4111
Mailing Address - Fax:
Practice Address - Street 1:1539 WHITESIDE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:HIGHLANDS
Practice Address - State:NC
Practice Address - Zip Code:28741-7564
Practice Address - Country:US
Practice Address - Phone:307-690-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY15711.0192363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYS67816Medicare UPIN