Provider Demographics
NPI:1891014775
Name:NOLAN, THERESA A (RN)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:NOLAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 COTTERMAN LN
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:OH
Mailing Address - Zip Code:45647-9778
Mailing Address - Country:US
Mailing Address - Phone:740-887-4796
Mailing Address - Fax:
Practice Address - Street 1:531 COTTERMAN LANE
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:OH
Practice Address - Zip Code:45647
Practice Address - Country:US
Practice Address - Phone:740-887-4796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN337692163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse