Healthcare Provider Details

I. General information

NPI: 1922573534
Provider Name (Legal Business Name): EMMA-ANN NOWAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 09/06/2021
Certification Date: 09/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SOLOMONS ISLAND RD N
PRINCE FREDERICK MD
20678-3917
US

IV. Provider business mailing address

13495 JOY RD
LUSBY MD
20657-2639
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-5400
  • Fax:
Mailing address:
  • Phone: 631-379-4831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number21932
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: