Provider Demographics
NPI:1730548751
Name:NOLT, SUSANNA (CNA,NHC)
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:
Last Name:NOLT
Suffix:
Gender:F
Credentials:CNA,NHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:MOHNTON
Mailing Address - State:PA
Mailing Address - Zip Code:19540-1338
Mailing Address - Country:US
Mailing Address - Phone:610-927-5136
Mailing Address - Fax:610-927-5136
Practice Address - Street 1:774 FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:MOHNTON
Practice Address - State:PA
Practice Address - Zip Code:19540-1338
Practice Address - Country:US
Practice Address - Phone:610-927-5136
Practice Address - Fax:610-927-5136
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education