MEDICARE: MRS. ANNA LANORA NOLETTE CPNP

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	363LP0200X	Pediatric Nurse Practitioner	1817	NE

General Provider Information

NPI Number	:	1548590730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNA LANORA NOLETTE CPNP

Provider Business Mailing Address
First Line	:	1111 S 84TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-1322
Country	:	US
Telephone Number	:	402-502-6751
Fax Number	:

Provider Business Practice Location Address
First Line	:	985160 NEBRASKA MEDICAL CTR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68198-5160
Country	:	US
Telephone Number	:	402-559-4028
Fax Number	:	402-559-9525

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

Provider Enumeration Date	:	01/11/2010
Last Update Date	:	01/11/2010

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