Provider Demographics
NPI:1275893927
Name:NOWAK, NATALIE (DO)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:NOWAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33369
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28233-3369
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1450 MATTHEWS TOWNSHIP PKWY STE 250
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5331
Practice Address - Country:US
Practice Address - Phone:704-841-1444
Practice Address - Fax:704-849-2520
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT014673208600000X
NC2017-01753208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1275893927Medicaid