Healthcare Provider Details

I. General information

NPI: 1720917511
Provider Name (Legal Business Name): EDWARD JOSEPH NOLAN III RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 19TH ST
WHEELING WV
26003-3715
US

IV. Provider business mailing address

PO BOX 6400
WHEELING WV
26003-0801
US

V. Phone/Fax

Practice location:
  • Phone: 304-234-3500
  • Fax:
Mailing address:
  • Phone: 304-234-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number23343
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: