Healthcare Provider Details

I. General information

NPI: 1184545436
Provider Name (Legal Business Name): MARIALISON NOWICKI FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARYALISON NOWICKI

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 MICHIGAN AVE STE 201
HOLLAND MI
49423-4911
US

IV. Provider business mailing address

328 TIMBERLAKE DR W
HOLLAND MI
49424-5315
US

V. Phone/Fax

Practice location:
  • Phone: 616-392-1816
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704341590
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: