=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487696555
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAUREEN LLOYD NOLAN CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2006
-----------------------------------------------------
Last Update Date | 06/09/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11 ROBINSON STREET SUITE 100
-----------------------------------------------------
City | POTTSTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19464-6439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-326-9460
-----------------------------------------------------
Fax | 610-326-2432
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 460 NORRISTOWN RD SUITE 100
-----------------------------------------------------
City | BLUE BELL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-941-6700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | SP008875
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------