MEDICARE: MR. JOHN PATRICK NOLAN M.S.

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1508034091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN PATRICK NOLAN M.S.

Provider Business Mailing Address
First Line	:	6015 DICHOTOMY CT
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-2063
Country	:	US
Telephone Number	:	260-348-0833
Fax Number	:	260-387-7490

Provider Business Practice Location Address
First Line	:	6015 DICHOTOMY CT
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-2063
Country	:	US
Telephone Number	:	260-348-0833
Fax Number	:	260-387-7490

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

Provider Enumeration Date	:	02/18/2008
Last Update Date	:	02/18/2008

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