Provider Demographics
NPI:1770685620
Name:KOWAL, NICOLETTE SYLVIA (FNP-BC, ACNS-BC)
Entity Type:Individual
Prefix:MS
First Name:NICOLETTE
Middle Name:SYLVIA
Last Name:KOWAL
Suffix:
Gender:F
Credentials:FNP-BC, ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50761 BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48047-1669
Mailing Address - Country:US
Mailing Address - Phone:586-484-9688
Mailing Address - Fax:586-204-0180
Practice Address - Street 1:50761 BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047-1669
Practice Address - Country:US
Practice Address - Phone:586-484-9688
Practice Address - Fax:586-204-0180
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0031410363LF0000X
INNP71014218A363LF0000X
MI4704175100363LF0000X
FLAPRN11024553363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM5862002Medicare ID - Type Unspecified