Provider Demographics
NPI:1114540705
Name:NOWICKI, MARIE-YACINTHE (NP)
Entity Type:Individual
Prefix:
First Name:MARIE-YACINTHE
Middle Name:
Last Name:NOWICKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 DASCOMB RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-5627
Mailing Address - Country:US
Mailing Address - Phone:978-409-2108
Mailing Address - Fax:
Practice Address - Street 1:29 DASCOMB RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-5627
Practice Address - Country:US
Practice Address - Phone:978-409-2108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN198520363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily