Healthcare Provider Details

I. General information

NPI: 1902062995
Provider Name (Legal Business Name): PATRICIA ANN NOLAN ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NESCONSET HWY BLDG 17A
STONY BROOK NY
11790-2563
US

IV. Provider business mailing address

2500 NESCONSET HWY BLDG 17A
STONY BROOK NY
11790-2563
US

V. Phone/Fax

Practice location:
  • Phone: 631-751-6262
  • Fax: 631-751-6268
Mailing address:
  • Phone: 631-751-6262
  • Fax: 631-751-6268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number304948
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: