Provider Demographics
NPI:1194733915
Name:NOWICKI, MARY J (CNM)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:NOWICKI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20800 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-4312
Mailing Address - Country:US
Mailing Address - Phone:216-333-1020
Mailing Address - Fax:216-331-4245
Practice Address - Street 1:20800 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-4312
Practice Address - Country:US
Practice Address - Phone:216-333-1020
Practice Address - Fax:440-331-4245
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN164655176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2444386Medicaid
OHNM03042Medicare PIN