Healthcare Provider Details

I. General information

NPI: 1174978779
Provider Name (Legal Business Name): BRITTANY LYNN NOLAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 LINCOLN BLVD
MARINA DEL REY CA
90292-6306
US

IV. Provider business mailing address

4650 LINCOLN BLVD
MARINA DEL REY CA
90292-6306
US

V. Phone/Fax

Practice location:
  • Phone: 310-823-8911
  • Fax:
Mailing address:
  • Phone: 310-823-8911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA53757
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: