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General NPI Number Information
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NPI Number | 1336809409
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Entity Type | Individual
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Provider Name | ERIC A. NOWACZYK
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Gender | Male
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Dates
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Enumeration Date | 12/30/2021
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Last Update Date | 12/30/2021
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Provider Practice Location Address
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Address Line | 255 W LANCASTER AVE
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City | PAOLI
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State | PA
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Zip | 19301-1763
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Country | US
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Telephone | 484-565-8319
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Fax |
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Provider Business Mailing Address
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Address Line | 26 GLEN LOCH WAY
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City | MALVERN
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State | PA
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Zip | 19355-1956
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Country | US
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Telephone | 610-656-8240
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | SP024937
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License Number State | PA
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