MEDICARE: JOEL MICHAEL NOLAND

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	8338061-4810	UT

General Provider Information

NPI Number	:	1285078493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL MICHAEL NOLAND

Provider Business Mailing Address
First Line	:	433 KENT DR
Second Line	:
City	:	NORTH SALT LAKE
State	:	UT
Zip	:	84054-6033
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	433 KENT DR
Second Line	:
City	:	NORTH SALT LAKE
State	:	UT
Zip	:	84054-6033
Country	:	US
Telephone Number	:	509-844-4042
Fax Number	:

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

Provider Enumeration Date	:	04/18/2013
Last Update Date	:	04/18/2013

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