Healthcare Provider Details

I. General information

NPI: 1265756381
Provider Name (Legal Business Name): SHANNON LEE NOLAN APN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 PENN ST
CAMDEN NJ
08102-1410
US

IV. Provider business mailing address

RUTGERS UNIVERSITY 326 PENN STREET
CAMDEN NJ
08102
US

V. Phone/Fax

Practice location:
  • Phone: 856-225-6005
  • Fax:
Mailing address:
  • Phone: 856-225-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00284100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: