Provider Demographics
NPI:1982645545
Name:NOWAK, JULIE
Entity Type:Individual
Prefix:MISS
First Name:JULIE
Middle Name:
Last Name:NOWAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4722
Mailing Address - Country:US
Mailing Address - Phone:716-839-1161
Mailing Address - Fax:716-839-4683
Practice Address - Street 1:2075 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:NY
Practice Address - Zip Code:14226-4722
Practice Address - Country:US
Practice Address - Phone:716-839-1161
Practice Address - Fax:716-839-4683
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3042791363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health