Provider Demographics
NPI:1013376425
Name:NOWAZEK, VIVIAN (PHD, MSN, RN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:NOWAZEK
Suffix:
Gender:F
Credentials:PHD, MSN, RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 S LOOP 336 W
Mailing Address - Street 2:STE 200
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3320
Mailing Address - Country:US
Mailing Address - Phone:936-525-3600
Mailing Address - Fax:936-525-3624
Practice Address - Street 1:690 S LOOP 336 W
Practice Address - Street 2:STE 200
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3320
Practice Address - Country:US
Practice Address - Phone:936-525-3600
Practice Address - Fax:936-525-3624
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP106516364SC0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine