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NPI 1952351215

NPI 1952351215 : JOHN NOLAN FP : ONEONTA, NY

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General NPI Number Information
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    NPI Number           |    1952351215
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    Entity Type          |    Individual 
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    Provider Name        |    JOHN NOLAN FP
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    05/10/2006
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    Last Update Date     |    04/27/2010
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Provider Practice Location Address
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    Address Line         |    1 FOX CARE DR 308
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    City                 |    ONEONTA
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    State                |    NY
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    Zip                  |    13820-2086
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    Country              |    US
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    Telephone            |    607-432-1163
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    Fax                  |    607-431-5367
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Provider Business Mailing Address
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    Address Line         |    1 FOX CARE DR 308
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    City                 |    ONEONTA
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    State                |    NY
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    Zip                  |    13820-2086
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    Country              |    US
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    Telephone            |    607-432-1163
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    Fax                  |    607-431-5367
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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        |    363AM0700X
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    Taxonomy Name        |    Medical Physician Assistant
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    License Number       |    010983
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    License Number State |    NY
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