Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 9711-33 | WI |
NPI | 1003459769 |
---|---|
Provider Name | Jessica Ann Nowak |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53715-1375 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2019 |
Last Update Date | 12/01/2021 |