Healthcare Provider Details

I. General information

NPI: 1326452376
Provider Name (Legal Business Name): JOANNA NOWAKOWSKI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 WARDENBURG DRIVE
BOULDER CO
80309-3511
US

IV. Provider business mailing address

119 UCB WARDENBURG
BOULDER CO
80309-0001
US

V. Phone/Fax

Practice location:
  • Phone: 303-492-5101
  • Fax: 303-492-6861
Mailing address:
  • Phone: 303-492-5101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11015095
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0994136
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: