Healthcare Provider Details

I. General information

NPI: 1811227119
Provider Name (Legal Business Name): KORENA NOLAN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 CENTRAL AVE
KEARNEY NE
68848
US

IV. Provider business mailing address

PO BOX 1715 3810 CENTRAL AVE
KEARNEY NE
68848
US

V. Phone/Fax

Practice location:
  • Phone: 308-237-5951
  • Fax:
Mailing address:
  • Phone: 308-237-5951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4044
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1438
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: