Provider Demographics
NPI:1134766314
Name:NOWACKI, MARIE (PPD)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:NOWACKI
Suffix:
Gender:F
Credentials:PPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 1/2 GLENHURST AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-2317
Mailing Address - Country:US
Mailing Address - Phone:425-422-8268
Mailing Address - Fax:
Practice Address - Street 1:2910 1/2 GLENHURST AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-2317
Practice Address - Country:US
Practice Address - Phone:425-422-8268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula