Healthcare Provider Details

I. General information

NPI: 1811212681
Provider Name (Legal Business Name): NOLAN MICHAEL NADZAM CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 E STATE ST
SALEM OH
44460-2423
US

IV. Provider business mailing address

3622 BELMONT AVE 1
YOUNGSTOWN OH
44505-1450
US

V. Phone/Fax

Practice location:
  • Phone: 330-759-9350
  • Fax: 330-759-9387
Mailing address:
  • Phone: 330-759-9350
  • Fax: 330-759-9387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCOA.11389-NA
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-288403
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: