1366819732 NPI number — MS. SHEILA KATHLEEN NOLAN CRNP

Table of content: MS. SHEILA KATHLEEN NOLAN CRNP (NPI 1366819732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366819732 NPI number — MS. SHEILA KATHLEEN NOLAN CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOLAN
Provider First Name:
SHEILA
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366819732
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10320 STRATHMORE HALL ST
Provider Second Line Business Mailing Address:
APT. 403
Provider Business Mailing Address City Name:
NORTH BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20852-6636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-709-4789
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15215 SHADY GROVE RD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-3235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-519-0902
Provider Business Practice Location Address Fax Number:
201-519-0905
Provider Enumeration Date:
09/01/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  R119085 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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