Provider Demographics
NPI:1598931149
Name:NOWACKI, ELIZABETH ANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANNE
Last Name:NOWACKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13914 SOUTHEASTERN PKWY
Mailing Address - Street 2:SUITE 314
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7127
Mailing Address - Country:US
Mailing Address - Phone:317-872-1415
Mailing Address - Fax:317-337-2571
Practice Address - Street 1:13914 SOUTHEASTERN PKWY
Practice Address - Street 2:SUITE 314
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7127
Practice Address - Country:US
Practice Address - Phone:317-872-1415
Practice Address - Fax:317-773-5945
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003298A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200913160Medicaid
INM400076047Medicare PIN