Provider Demographics
NPI:1376010413
Name:NOWAK, RYLEE (LPN)
Entity Type:Individual
Prefix:
First Name:RYLEE
Middle Name:
Last Name:NOWAK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-3453
Mailing Address - Country:US
Mailing Address - Phone:563-262-6263
Mailing Address - Fax:563-262-2037
Practice Address - Street 1:1616 CEDAR ST
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-3453
Practice Address - Country:US
Practice Address - Phone:563-262-6263
Practice Address - Fax:563-262-2037
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP59875364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health