Provider Demographics
NPI:1770288300
Name:NOWAK-TIPPY, STEPHANIE (BSTN, CDSP, CNC,)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:NOWAK-TIPPY
Suffix:
Gender:
Credentials:BSTN, CDSP, CNC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 PHOENIX ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49090-1408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:509 PHOENIX ST
Practice Address - Street 2:
Practice Address - City:SOUTH HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49090-1408
Practice Address - Country:US
Practice Address - Phone:269-737-9277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2025-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach