Healthcare Provider Details

I. General information

NPI: 1376651158
Provider Name (Legal Business Name): BARBARA EMMA NOLAN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 N RIVER RD
WEST LAFAYETTE BRA IN
47906-3762
US

IV. Provider business mailing address

3851 NORTH RIVER ROAD DEHART BUILDING, OFFICE 8A
WEST LAFAYETTE IN
47906
US

V. Phone/Fax

Practice location:
  • Phone: 765-464-2280
  • Fax: 765-464-2279
Mailing address:
  • Phone: 765-464-2280
  • Fax: 765-464-2279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37000737A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: