Provider Demographics
NPI:1508004748
Name:NOWICKI, BERNARD DENNIS (HIS DISPENCER)
Entity Type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:DENNIS
Last Name:NOWICKI
Suffix:
Gender:M
Credentials:HIS DISPENCER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14021 N 51ST AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4838
Mailing Address - Country:US
Mailing Address - Phone:602-863-1020
Mailing Address - Fax:602-863-1020
Practice Address - Street 1:14021 N 51ST AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4838
Practice Address - Country:US
Practice Address - Phone:602-863-1020
Practice Address - Fax:602-863-1020
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1351237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist