Provider Demographics
NPI:1083965875
Name:NOWAKOWSKI, AGNES (LAC)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:
Last Name:NOWAKOWSKI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 JUNIPER TRCE
Mailing Address - Street 2:STE 107
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-5506
Mailing Address - Country:US
Mailing Address - Phone:512-215-9847
Mailing Address - Fax:
Practice Address - Street 1:3821 JUNIPER TRCE
Practice Address - Street 2:STE 107
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-5506
Practice Address - Country:US
Practice Address - Phone:512-215-9847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01315171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist