Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 56663 | MN |
N | 111NI0900X | Internist | 56663 | MN |
N | 207RC0200X | Critical Care Medicine | 68885 | WI |
N | 207RP1001X | Pulmonary Disease | 56663 | MN |
Y | 207RP1001X | Pulmonary Disease | 68885 | WI |
NPI | 1043574007 |
---|---|
Provider Name | Matthew Nolan |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2012 |
Last Update Date | 07/01/2021 |