MEDICARE: NOLAN HARTZELL ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1063937837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOLAN HARTZELL ATC

Provider Business Mailing Address
First Line	:	6020 FAIRLANE DR
Second Line	:
City	:	CLARENCE CENTER
State	:	NY
Zip	:	14032-9733
Country	:	US
Telephone Number	:	716-982-3684
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 I ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20052-0086
Country	:	US
Telephone Number	:	716-982-3684
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2017
Last Update Date	:	08/14/2017

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Directions to “ NOLAN HARTZELL ATC” Practice Location

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