Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 16392 | TN |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 5009709 | NC |
NPI | 1033489943 |
---|---|
Provider Name | Brook Payne Nowak |
First Address | Raleigh, NC 27607-7505 |
Second Address | Raleigh, NC 27607-7505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2012 |
Last Update Date | 27/10/2020 |