Healthcare Provider Details

I. General information

NPI: 1508004748
Provider Name (Legal Business Name): BERNARD DENNIS NOWICKI HIS DISPENCER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14021 N 51ST AVE SUITE 101
GLENDALE AZ
85306-4838
US

IV. Provider business mailing address

14021 N 51ST AVE SUITE 101
GLENDALE AZ
85306-4838
US

V. Phone/Fax

Practice location:
  • Phone: 602-863-1020
  • Fax: 602-863-1020
Mailing address:
  • Phone: 602-863-1020
  • Fax: 602-863-1020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1351
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: