Provider Demographics
NPI:1770685620
Name:KOWAL, NICOLETTE SYLVIA (FNP-BC, ACNS-BC)
Entity type:Individual
Prefix:MS
First Name:NICOLETTE
Middle Name:SYLVIA
Last Name:KOWAL
Suffix:
Gender:
Credentials:FNP-BC, ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MARINE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48039-1680
Mailing Address - Country:US
Mailing Address - Phone:810-765-8750
Mailing Address - Fax:810-765-4326
Practice Address - Street 1:130 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARINE CITY
Practice Address - State:MI
Practice Address - Zip Code:48039-1680
Practice Address - Country:US
Practice Address - Phone:810-765-8750
Practice Address - Fax:810-765-4326
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0031410363LF0000X
INNP71014218A363LF0000X
FLAPRN11024553363LF0000X
MI4704175100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1154447464OtherNPPES