Healthcare Provider Details

I. General information

NPI: 1588343784
Provider Name (Legal Business Name): NOLAN BRIAN ANDRE APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7543 SANTA MONICA BLVD
WEST HOLLYWOOD CA
90046-6406
US

IV. Provider business mailing address

7543 SANTA MONICA BLVD
WEST HOLLYWOOD CA
90046-6406
US

V. Phone/Fax

Practice location:
  • Phone: 909-518-4588
  • Fax:
Mailing address:
  • Phone: 323-988-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1126556
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95031699
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: