Provider Demographics
NPI:1134258700
Name:NOWOSAD, ANDREW R (LAC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:R
Last Name:NOWOSAD
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:R
Other - Last Name:NOWOSAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:6216 FAYETTEVILLE RD STE 101A
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6750
Mailing Address - Country:US
Mailing Address - Phone:919-973-3042
Mailing Address - Fax:919-724-4113
Practice Address - Street 1:6216 FAYETTEVILLE RD STE 101A
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713
Practice Address - Country:US
Practice Address - Phone:919-973-3042
Practice Address - Fax:919-724-4113
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC487171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist