Provider Demographics
NPI:1609200690
Name:NOLAN, JULENE D (PSYD)
Entity type:Individual
Prefix:DR
First Name:JULENE
Middle Name:D
Last Name:NOLAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CIVIC CENTER PLZ
Mailing Address - Street 2:SUITE 1615
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-7781
Mailing Address - Country:US
Mailing Address - Phone:507-345-4679
Mailing Address - Fax:597-345-8685
Practice Address - Street 1:12 CIVIC CENTER PLZ
Practice Address - Street 2:SUITE 1615
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-7781
Practice Address - Country:US
Practice Address - Phone:507-345-4679
Practice Address - Fax:597-345-8685
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN468441103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool