Healthcare Provider Details

I. General information

NPI: 1265508196
Provider Name (Legal Business Name): KAREN MARIE NOLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 PEARL ST
BROCKTON MA
02301-2817
US

IV. Provider business mailing address

150 S HUNTINGTON AVE
BOSTON MA
02130-4817
US

V. Phone/Fax

Practice location:
  • Phone: 508-580-1020
  • Fax: 508-583-6232
Mailing address:
  • Phone: 857-364-5804
  • Fax: 857-364-6604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number146712
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number146712
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: