MEDICARE: CATHERINE H NOWKA FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	4704135726	MI

General Provider Information

NPI Number	:	1902988777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE H NOWKA FNP

Provider Business Mailing Address
First Line	:	580 S. NICOLET STREET
Second Line	:	P.O. BOX 868
City	:	MACKINAW CITY
State	:	MI
Zip	:	49701
Country	:	US
Telephone Number	:	231-436-9900
Fax Number	:	231-436-5357

Provider Business Practice Location Address
First Line	:	580 S. NICOLET STREET
Second Line	:
City	:	MACKINAW CITY
State	:	MI
Zip	:	49701
Country	:	US
Telephone Number	:	231-436-9900
Fax Number	:	231-436-5357

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	03/11/2010

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