Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 49347 | KY |
N | 207PE0004X | Emergency Medical Services | 26965 | WV |
NPI | 1033272943 |
---|---|
Provider Name | Marie Nowak |
First Address | Cincinnati, OH 45263-6961 |
Second Address | Paducah, KY 42003-7901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 28/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F48377 | (02) | IL |