Provider Demographics
NPI:1942701669
Name:NOWACKI, REBECCA ANNE MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE MARIE
Last Name:NOWACKI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:131-752-8480
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:701 SUPERIOR AVE STE J
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-4038
Practice Address - Country:US
Practice Address - Phone:219-934-9796
Practice Address - Fax:219-934-4075
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAN360841509363L00000X, 363LF0000X
IN71010798A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner