Provider Demographics
NPI:1710779434
Name:NOWELL, LOUISE
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:NOWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3728 S 43RD ST APT 8
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53220-2159
Mailing Address - Country:US
Mailing Address - Phone:414-202-8854
Mailing Address - Fax:
Practice Address - Street 1:3728 S 43RD ST APT 8
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53220-2159
Practice Address - Country:US
Practice Address - Phone:414-202-8854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
WI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker