MEDICARE: JOSEPH L NOLEN STNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	400210950203	OH

General Provider Information

NPI Number	:	1104184050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH L NOLEN STNA

Provider Business Mailing Address
First Line	:	1215 W 10TH ST
Second Line	:	526
City	:	CLEVELAND
State	:	OH
Zip	:	44113-1291
Country	:	US
Telephone Number	:	216-835-1836
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 W 10TH ST
Second Line	:	526
City	:	CLEVELAND
State	:	OH
Zip	:	44113-1291
Country	:	US
Telephone Number	:	216-835-1836
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2012
Last Update Date	:	04/29/2012

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Directions to “ JOSEPH L NOLEN STNA” Practice Location

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