Provider Demographics
NPI:1780202879
Name:NOWAK, JOSEPHINE CLAIRE (CNM)
Entity Type:Individual
Prefix:MS
First Name:JOSEPHINE
Middle Name:CLAIRE
Last Name:NOWAK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WILCOX DR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-4678
Mailing Address - Country:US
Mailing Address - Phone:630-479-0451
Mailing Address - Fax:
Practice Address - Street 1:328 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2895
Practice Address - Country:US
Practice Address - Phone:847-475-1224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209.021646OtherIDFPR