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General NPI Number Information
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NPI Number | 1710166004
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Entity Type | Organization
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Legal Business Name | L. WILLIAM D. NOWIERSKI, M.D. PA
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Dates
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Enumeration Date | 11/02/2007
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Last Update Date | 11/02/2007
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Provider Practice Location Address
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Address Line | 100 WARM SPRINGS AVE STE. A
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City | BOISE
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State | ID
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Zip | 83712-6243
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Country | US
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Telephone | 208-343-5910
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Fax | 208-384-8562
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Provider Business Mailing Address
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Address Line | 100 WARM SPRINGS AVE STE. A
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City | BOISE
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State | ID
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Zip | 83712-6243
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Country | US
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Telephone | 208-343-5910
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Fax | 208-384-8562
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. L. WILLIAM D NOWIERSKI
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Credential | M.D.
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Telephone | 208-343-5910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | M4341
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License Number State | ID
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