Provider Demographics
NPI:1902990294
Name:NOWAK, MORGAN LOUISE (PA)
Entity Type:Individual
Prefix:MRS
First Name:MORGAN
Middle Name:LOUISE
Last Name:NOWAK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:43308 BURKE DALE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH RIDING
Mailing Address - State:VA
Mailing Address - Zip Code:20152-1712
Mailing Address - Country:US
Mailing Address - Phone:703-327-3380
Mailing Address - Fax:
Practice Address - Street 1:6355 WALKER LN
Practice Address - Street 2:SUITE 411
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3245
Practice Address - Country:US
Practice Address - Phone:703-313-0373
Practice Address - Fax:703-719-0400
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2014-07-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110001348363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical