Individual
MR. NOLAN BASHORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-S3
Contact information
Practice address
21498 ARBOR GLEN CT, BROADLANDS, VA 20148-5070
(571) 577-7043
Mailing address
21498 ARBOR GLEN CT, BROADLANDS, VA 20148-5070
(571) 577-7043
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
363875188017
—
VA
Enumeration date
05/18/2026
Last updated
05/18/2026
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