Provider Demographics
NPI:1215124557
Name:NOLAND, BILL S JR (CRNP)
Entity type:Individual
Prefix:
First Name:BILL
Middle Name:S
Last Name:NOLAND
Suffix:JR
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 VILLAGE PROFESSIONAL DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-4785
Mailing Address - Country:US
Mailing Address - Phone:334-749-6523
Mailing Address - Fax:334-742-0242
Practice Address - Street 1:2609 VILLAGE PROFESSIONAL DR
Practice Address - Street 2:SUITE 3
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-4785
Practice Address - Country:US
Practice Address - Phone:334-749-6523
Practice Address - Fax:334-742-0242
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-041332163WN0300X
AL2716363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WN0300XNursing Service ProvidersRegistered NurseNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1215124557OtherNPI
AL122759Medicaid
AL122762Medicaid
AL1134289580Medicaid
AL528701590Medicaid
1215124557OtherNPI
AL122761Medicaid
AL122756Medicaid
AL122765Medicaid
ALCC1726OtherRRMC
AL122760Medicaid
AL122761Medicaid