Provider Demographics
NPI:1558698712
Name:NOWICKA, BOZENA URSZULA
Entity Type:Individual
Prefix:MRS
First Name:BOZENA
Middle Name:URSZULA
Last Name:NOWICKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3408 MONTEREY LN NE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-2096
Mailing Address - Country:US
Mailing Address - Phone:425-255-6580
Mailing Address - Fax:
Practice Address - Street 1:3408 MONTEREY LN NE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-2096
Practice Address - Country:US
Practice Address - Phone:425-255-6580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60112426225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist