Individual
DERICK NOWACKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
501 BRADDOCK AVE, BRADDOCK, PA 15104-1856
(412) 636-5050
(412) 753-7627
Mailing address
501 BRADDOCK AVE, BRADDOCK, PA 15104-1856
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
SP032116
PA
261QU0200X
Urgent Care Clinic/Center
Primary
SP032116
PA
363LF0000X
Family Nurse Practitioner
SP032116
PA
Other
Enumeration date
02/06/2025
Last updated
07/02/2025
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