Healthcare Provider Details

I. General information

NPI: 1679831655
Provider Name (Legal Business Name): MELISSA RENEE NOWICKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA RENEE BROWN N.P

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 S 20TH ST
MILWAUKEE WI
53215-4940
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 414-645-1808
  • Fax:
Mailing address:
  • Phone: 414-645-1808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4775-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: