Healthcare Provider Details

I. General information

NPI: 1750869426
Provider Name (Legal Business Name): JUDITH ANNE NOLAN RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 CAMPUS DR STE 206B
DALY CITY CA
94015-4932
US

IV. Provider business mailing address

901 CAMPUS DR
DALY CITY CA
94015-4900
US

V. Phone/Fax

Practice location:
  • Phone: 650-356-8800
  • Fax: 650-376-5511
Mailing address:
  • Phone: 506-356-8800
  • Fax: 650-376-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95013919
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95102341
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: