Healthcare Provider Details

I. General information

NPI: 1700235280
Provider Name (Legal Business Name): NOLAN WINSLOW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 S RIFE MEDICAL LN STE 140
ROGERS AR
72758-1455
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-6084
US

V. Phone/Fax

Practice location:
  • Phone: 479-338-3720
  • Fax: 479-338-3749
Mailing address:
  • Phone: 479-338-3720
  • Fax: 479-338-3749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number125.068677
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberE-18933
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: