Provider Demographics
NPI:1447459854
Name:NOLLIE, RAFAEL J (CSA/LPN)
Entity type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:J
Last Name:NOLLIE
Suffix:
Gender:M
Credentials:CSA/LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3470 OLNEY LAYTONSVILLE RD
Mailing Address - Street 2:SUITE 182
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1734
Mailing Address - Country:US
Mailing Address - Phone:972-363-8198
Mailing Address - Fax:
Practice Address - Street 1:3470 OLNEY LAYTONSVILLE RD
Practice Address - Street 2:SUITE 182
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1734
Practice Address - Country:US
Practice Address - Phone:301-363-4934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3077246ZC0007X
MDLP49426164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant