Healthcare Provider Details

I. General information

NPI: 1386314912
Provider Name (Legal Business Name): ANGELA MARIE NOWACKI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 LOCUST ST
PITTSBURGH PA
15219-5114
US

IV. Provider business mailing address

1400 LOCUST ST
PITTSBURGH PA
15219-5114
US

V. Phone/Fax

Practice location:
  • Phone: 412-232-8111
  • Fax:
Mailing address:
  • Phone: 412-232-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA064789
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMA064789
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: