Provider Demographics
NPI:1053023754
Name:NOLAN, SUSAN LYNN (MSN, RN)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LYNN
Last Name:NOLAN
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 OAKLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLYN
Mailing Address - State:NJ
Mailing Address - Zip Code:08107-1314
Mailing Address - Country:US
Mailing Address - Phone:856-957-5440
Mailing Address - Fax:856-957-5441
Practice Address - Street 1:415 OAKLAWN AVE
Practice Address - Street 2:
Practice Address - City:OAKLYN
Practice Address - State:NJ
Practice Address - Zip Code:08107-1314
Practice Address - Country:US
Practice Address - Phone:856-957-5440
Practice Address - Fax:856-957-5441
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR10802500163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management