Individual
SHANNON L NOLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
13616 CALIFORNIA ST, STE 100, OMAHA, NE 68154-5335
(402) 496-0404
(402) 496-0517
Mailing address
13616 CALIFORNIA ST, STE 100, OMAHA, NE 68154-5335
(402) 496-0404
(402) 496-0517
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1206
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
279884
MEDICARE
NE
01
—
37976
BCBS
NE
05
—
47081304012
—
NE
01
—
68154A022
TRICARE
NE
01
—
P00337631
RR MEDICARE
NE
Enumeration date
07/18/2006
Last updated
01/28/2009
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