Provider Demographics
NPI:1275252793
Name:NOWACK, CAISIE NICHOLE (DNP-FNP)
Entity Type:Individual
Prefix:DR
First Name:CAISIE
Middle Name:NICHOLE
Last Name:NOWACK
Suffix:
Gender:F
Credentials:DNP-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:OWENSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65066-1336
Mailing Address - Country:US
Mailing Address - Phone:573-301-2941
Mailing Address - Fax:
Practice Address - Street 1:101 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:OWENSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65066-1336
Practice Address - Country:US
Practice Address - Phone:573-201-3113
Practice Address - Fax:573-240-9720
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022033688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily