Provider Demographics
NPI:1265655393
Name:NOWKA, MICHELLE RENEE
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:RENEE
Last Name:NOWKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 MALLARD LN STE B
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-8770
Mailing Address - Country:US
Mailing Address - Phone:530-621-7596
Mailing Address - Fax:530-295-2713
Practice Address - Street 1:2808 MALLARD LN STE B
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-8770
Practice Address - Country:US
Practice Address - Phone:530-621-7596
Practice Address - Fax:530-295-2713
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3478OtherCLINICIAN NUMBER