MEDICARE: DR. NEFERTITI L. NOWELL PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor		IL

General Provider Information

NPI Number	:	1659344828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEFERTITI L. NOWELL PHD

Provider Business Mailing Address
First Line	:	28361 DIEHL ROAD
Second Line	:	SUITE B221
City	:	WARRENVILLE
State	:	IL
Zip	:	60555
Country	:	US
Telephone Number	:	866-397-0521
Fax Number	:	866-397-0521

Provider Business Practice Location Address
First Line	:	1979 N MILL ST
Second Line	:	SUITE 202
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-1200
Country	:	US
Telephone Number	:	866-397-0521
Fax Number	:	866-397-0521

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	07/08/2007

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