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General NPI Number Information
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NPI Number | 1013122647
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Entity Type | Individual
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Provider Name | MR. RODERICK LENARD NOLEN
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Gender | Male
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 505 W GRAND AVE
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City | HOT SPRINGS
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State | AR
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Zip | 71901-3931
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Country | US
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Telephone | 501-624-7111
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Fax | 501-620-5112
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Provider Business Mailing Address
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Address Line | PO BOX 6399
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City | HOT SPRINGS
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State | AR
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Zip | 71902-6399
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Country | US
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Telephone | 501-620-5130
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Fax | 501-620-5203
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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