Provider Demographics
NPI:1861066433
Name:NOWAK, STACY ANN (RN, CCM)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:ANN
Last Name:NOWAK
Suffix:
Gender:F
Credentials:RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24230 KARIM BLVD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2960
Mailing Address - Country:US
Mailing Address - Phone:248-745-4900
Mailing Address - Fax:248-994-8005
Practice Address - Street 1:24230 KARIM BLVD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2960
Practice Address - Country:US
Practice Address - Phone:248-745-4900
Practice Address - Fax:248-994-8005
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704272127163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management