Provider Demographics
NPI:1497780688
Name:NOWAK, CATHERINE M (PA-C)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:NOWAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SUSAN DR
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:NY
Mailing Address - Zip Code:10589-2505
Mailing Address - Country:US
Mailing Address - Phone:914-277-7266
Mailing Address - Fax:
Practice Address - Street 1:12 SUSAN DR
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:NY
Practice Address - Zip Code:10589-2505
Practice Address - Country:US
Practice Address - Phone:914-277-7266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001407363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P99491Medicare UPIN