Healthcare Provider Details

I. General information

NPI: 1275156242
Provider Name (Legal Business Name): NOLAN LYDA DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2020
Last Update Date: 03/13/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 6TH AVE S
BIRMINGHAM AL
35233-1932
US

IV. Provider business mailing address

MARTIN ARMY COMMUNITY HOSPITAL 6600 VAN AALST BLVD. BLD 9250
FT. BENNING GA
31905
US

V. Phone/Fax

Practice location:
  • Phone: 205-960-0966
  • Fax:
Mailing address:
  • Phone: 762-408-0456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-150278
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: