MEDICARE: KAITLIN NOLAN 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	SP013593	PA

General Provider Information

NPI Number	:	1467870089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN NOLAN CRNP

Provider Business Mailing Address
First Line	:	933 LIBERTY AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15222-3701
Country	:	US
Telephone Number	:	412-434-8957
Fax Number	:	412-434-8974

Provider Business Practice Location Address
First Line	:	933 LIBERTY AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15222-3701
Country	:	US
Telephone Number	:	412-434-8957
Fax Number	:	412-434-8974

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

Provider Enumeration Date	:	04/01/2014
Last Update Date	:	10/12/2014

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