=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770685620
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLETTE SYLVIA KOWAL FNP-BC, ACNS-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2006
-----------------------------------------------------
Last Update Date | 04/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 WASHINGTON ST
-----------------------------------------------------
City | MARINE CITY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48039-1680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-765-8750
-----------------------------------------------------
Fax | 810-765-4326
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 130 WASHINGTON ST
-----------------------------------------------------
City | MARINE CITY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48039-1680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-765-8750
-----------------------------------------------------
Fax | 810-765-4326
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.0031410
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | NP71014218A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN11024553
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 4704175100
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------