Healthcare Provider Details

I. General information

NPI: 1033532320
Provider Name (Legal Business Name): DEBORAH NOWACK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2014
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 HILLANDALE RD SUITE 24B
DURHAM NC
27705-2659
US

IV. Provider business mailing address

PO BOX 751274
CHARLOTTE NC
28275-1274
US

V. Phone/Fax

Practice location:
  • Phone: 919-383-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number49088
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: