Provider Demographics
NPI:1053132365
Name:BULAND, NOLAN PATRICK (RD LD)
Entity type:Individual
Prefix:
First Name:NOLAN
Middle Name:PATRICK
Last Name:BULAND
Suffix:
Gender:M
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3167 CUSTER DR STE 301
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4018
Mailing Address - Country:US
Mailing Address - Phone:859-388-9152
Mailing Address - Fax:859-208-2234
Practice Address - Street 1:3167 CUSTER DR STE 301
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4018
Practice Address - Country:US
Practice Address - Phone:859-388-9152
Practice Address - Fax:859-208-2234
Is Sole Proprietor?:No
Enumeration Date:2024-10-19
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY281246133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered