Provider Demographics
NPI:1609681733
Name:CLAY, NOLAN WILLIAM
Entity type:Individual
Prefix:
First Name:NOLAN
Middle Name:WILLIAM
Last Name:CLAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1092 HAMPTON LN
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-3221
Mailing Address - Country:US
Mailing Address - Phone:847-951-5360
Mailing Address - Fax:
Practice Address - Street 1:1092 HAMPTON LN
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-3221
Practice Address - Country:US
Practice Address - Phone:847-951-5360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program