Provider Demographics
NPI:1558852699
Name:NOWICKI, JENA C (NP-C)
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:C
Last Name:NOWICKI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5775 E STATE ROUTE 113
Mailing Address - Street 2:
Mailing Address - City:COAL CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60416-7111
Mailing Address - Country:US
Mailing Address - Phone:815-634-0100
Mailing Address - Fax:815-634-2900
Practice Address - Street 1:5775 E STATE ROUTE 113
Practice Address - Street 2:
Practice Address - City:COAL CITY
Practice Address - State:IL
Practice Address - Zip Code:60416-7111
Practice Address - Country:US
Practice Address - Phone:815-634-0100
Practice Address - Fax:815-634-2900
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017696363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily