1770149510 NPI number — DR. RACHEL HANEY NOLAN MD

Table of content: DR. RACHEL HANEY NOLAN MD (NPI 1770149510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770149510 NPI number — DR. RACHEL HANEY NOLAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOLAN
Provider First Name:
RACHEL
Provider Middle Name:
HANEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1770149510
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 635283
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-5283
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-442-6600
Provider Business Mailing Address Fax Number:
859-442-6601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 CONNER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEBRON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41048-8169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-442-6200
Provider Business Practice Location Address Fax Number:
859-442-6601
Provider Enumeration Date:
05/17/2019

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 58728 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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