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General NPI Number Information
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NPI Number | 1942701669
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Entity Type | Individual
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Provider Name | REBECCA ANNE MARIE NOWACKI ARNP
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Gender | Female
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Dates
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Enumeration Date | 02/27/2018
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Last Update Date | 03/18/2021
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Provider Practice Location Address
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Address Line | 701 SUPERIOR AVE STE J
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City | MUNSTER
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State | IN
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Zip | 46321-4038
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Country | US
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Telephone | 219-934-9796
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Fax | 219-934-4075
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Provider Business Mailing Address
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Address Line | PO BOX 781076
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City | DETROIT
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State | MI
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Zip | 48278-1076
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Country | US
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Telephone | 131-752-8480
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Fax | 317-865-1479
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | N360841509
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | N360841509
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71010798A
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License Number State | IN
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