MEDICARE: NOLAMI AESTHETICS & MEDICINE, LLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1639936156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOLAMI AESTHETICS & MEDICINE, LLC

Provider Business Mailing Address
First Line	:	509 SEABURY AVE
Second Line	:
City	:	MILFORD
State	:	DE
Zip	:	19963-2216
Country	:	US
Telephone Number	:	302-382-8183
Fax Number	:

Provider Business Practice Location Address
First Line	:	35141 ATLANTIC AVE
Second Line	:
City	:	MILLVILLE
State	:	DE
Zip	:	19967-6954
Country	:	US
Telephone Number	:	302-382-8183
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	KATHLEEN HUDSON
Credential	:	APRN, FNP-C
Telephone Number	:	302-382-8183

Provider Enumeration Date	:	03/01/2024
Last Update Date	:	03/01/2024

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