MEDICARE: MR. NOLAN PAUL HERRELL PA

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	363A00000X	Physician Assistant	085010528	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427804400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NOLAN PAUL HERRELL PA

Provider Business Mailing Address
First Line	:	PO BOX 7412011
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-2011
Country	:	US
Telephone Number	:	618-257-5902
Fax Number	:	618-257-6671

Provider Business Practice Location Address
First Line	:	4700 MEMORIAL DR
Second Line	:	DIV WUPI NEUROSURGERY, STE 230
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-5373
Country	:	US
Telephone Number	:	618-257-5902
Fax Number	:	618-257-6671

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

Provider Enumeration Date	:	04/29/2024
Last Update Date	:	02/20/2026

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