1144552233 NPI number — MICHAEL JOSEPEH NOLAN ATC

Table of content: JOANNE NACHTYGAL PA (NPI 1144365016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144552233 NPI number — MICHAEL JOSEPEH NOLAN ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOLAN
Provider First Name:
MICHAEL
Provider Middle Name:
JOSEPEH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ATC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144552233
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 S KINGSHIGHWAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CHARLES
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63301-1695
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-339-6951
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2532 SIMS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63114-3204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-882-7665
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  2011026856 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2000000863 . This is a "NATABOC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2011026856 . This is a "DIVISION OF PROFRESSIONAL REGULATION" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".