Healthcare Provider Details

I. General information

NPI: 1558093567
Provider Name (Legal Business Name): MARTHA NOWACKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY DR STE 200
DUBUQUE IA
52001-7392
US

IV. Provider business mailing address

620 W 7TH ST
DUBUQUE IA
52001-6619
US

V. Phone/Fax

Practice location:
  • Phone: 563-582-0145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: