# SANDRA J NOLAN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1427054774
- **Gender:** F
- **Credential:** APRN

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163W00000X | Registered Nurse | 14-134927-112 | KS | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 096307 | MO | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 2090009004 | IL | — |

## Other

- **Enumeration date:** 06/22/2005
- **Last updated:** 01/16/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 096307 | LICENSE | MO |
| 01 | — | 0MT0372665 | BLUE CROSS-SHIELD OF MONTANA | MT |
| 05 | — | 424769115 | — | MO |