Provider Demographics
NPI:1861971137
Name:NOWICKI, BRENT ANDREW (PA)
Entity type:Individual
Prefix:MR
First Name:BRENT
Middle Name:ANDREW
Last Name:NOWICKI
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:5755 S MAYFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-4115
Mailing Address - Country:US
Mailing Address - Phone:440-986-1144
Mailing Address - Fax:
Practice Address - Street 1:2600 6TH ST SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1702
Practice Address - Country:US
Practice Address - Phone:330-452-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2022-07-01
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant