MEDICARE: MS. KARA A NOLAN CISW

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	104100000X	Social Worker	CISW SW29751	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SW29751	OTHER	AZ	CISW

General Provider Information

NPI Number	:	1477600138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KARA A NOLAN CISW

Provider Business Mailing Address
First Line	:	4915 W BELL RD
Second Line	:	SUITE202
City	:	GLENDALE
State	:	AZ
Zip	:	85308-3425
Country	:	US
Telephone Number	:	602-882-3284
Fax Number	:	602-938-6640

Provider Business Practice Location Address
First Line	:	4915 W BELL RD
Second Line	:	SUITE202
City	:	GLENDALE
State	:	AZ
Zip	:	85308-3425
Country	:	US
Telephone Number	:	602-882-3284
Fax Number	:	602-938-6640

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	11/30/2016

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