1831247154 NPI number — MR. STEVEN CARLTON NOLAN M.A., CCC-A

Table of content: MR. STEVEN CARLTON NOLAN M.A., CCC-A (NPI 1831247154)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831247154 NPI number — MR. STEVEN CARLTON NOLAN M.A., CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOLAN
Provider First Name:
STEVEN
Provider Middle Name:
CARLTON
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.A., CCC-A
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:
1831247154
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6877 HIGHLAND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANITE BAY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95746-8169
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-791-2671
Provider Business Mailing Address Fax Number:
916-771-6681

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2120 PROFESSIONAL DR
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95661-3700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-771-6680
Provider Business Practice Location Address Fax Number:
916-771-6681
Provider Enumeration Date:
01/05/2007

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: 231H00000X , with the licence number:  AU-328 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 237600000X , with the licence number: HA-3940 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: HA-3940 . This is a "HEARING AID FITTER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: AU-328 . This is a "AUDIOLOGY LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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