| Doctor Name: | JUSTIN D NOLEN |
| NPI Number: | 1366743569 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP |
| License Number: | 11904-NP |
| Business Practice Address: | 10 Thomas Hollow Rd Lucasville, OH - 456488889 |
| Business Phone Number: | 7402595699 |
| Business Fax Number: | 7402592186 |
| Mailing Address: | 1735 27th St, Waller Building, Suite B06 PORTSMOUTH |
| State: | OH |
| Postal Code: | 456622677 |
| Phone Number: | 7403568681 |
| Fax Number: | 7403537900 |
| NPI Enumeration Date: | 11/04/2010 |
| NPI Last Update Date: | 10/05/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 11904-NP |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |