Provider Demographics
NPI:1992095954
Name:NOWAK, BRITTANY R
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:R
Last Name:NOWAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:
Other - Last Name:NEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:313 W WOLF POINT PLZ UNIT 5402
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-8916
Mailing Address - Country:US
Mailing Address - Phone:765-894-1144
Mailing Address - Fax:
Practice Address - Street 1:3307 W 96TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1106
Practice Address - Country:US
Practice Address - Phone:317-876-3699
Practice Address - Fax:317-674-0059
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28188947A163WP0808X
IN71010009A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71010009AOtherLICENSE NO.
INMN5871101OtherDEA