Healthcare Provider Details

I. General information

NPI: 1043981434
Provider Name (Legal Business Name): SALEEN M NOLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2021
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 ELKINS AVE
DAYTON OH
45417-8658
US

IV. Provider business mailing address

192 ELKINS AVE
DAYTON OH
45417-8658
US

V. Phone/Fax

Practice location:
  • Phone: 937-516-8330
  • Fax:
Mailing address:
  • Phone: 937-516-8330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberSP400006
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberSP400006
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: