MEDICARE: NOLAN PENN BAULDREE CRNP

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	363LF0000X	Family Nurse Practitioner	1-159160	AL

General Provider Information

NPI Number	:	1427642594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOLAN PENN BAULDREE CRNP

Provider Business Mailing Address
First Line	:	3106 INDEPENDENCE DR
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-4112
Country	:	US
Telephone Number	:	205-871-7007
Fax Number	:

Provider Business Practice Location Address
First Line	:	2556 HELENA RD STE C
Second Line	:
City	:	HELENA
State	:	AL
Zip	:	35080-3260
Country	:	US
Telephone Number	:	205-685-4870
Fax Number	:	205-685-4869

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

Provider Enumeration Date	:	03/01/2021
Last Update Date	:	02/02/2023

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