Healthcare Provider Details

I. General information

NPI: 1942353420
Provider Name (Legal Business Name): CHERYL A NOWACKI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W UNIVERSITY DR
ROCHESTER MI
48307-1863
US

IV. Provider business mailing address

4029 WINCREST LN
ROCHESTER MI
48306-4770
US

V. Phone/Fax

Practice location:
  • Phone: 248-652-5354
  • Fax: 248-652-5861
Mailing address:
  • Phone: 248-475-0967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704144391
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: