Healthcare Provider Details

I. General information

NPI: 1710814173
Provider Name (Legal Business Name): MARISSA VALERIE NOWAK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

858 N CHERRY ST
TULARE CA
93274-2243
US

IV. Provider business mailing address

2731 W TYLER AVE
VISALIA CA
93291-8085
US

V. Phone/Fax

Practice location:
  • Phone: 877-960-3426
  • Fax:
Mailing address:
  • Phone: 323-717-8566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95034798
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: