Individual
TIA NOWACKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, NBC-HWC
Contact information
Practice address
5155 S HILLSDALE AVE, MERIDIAN, ID 83642-7587
(208) 706-9710
Mailing address
3001 132ND AVE NW, SPICER, MN 56288-9469
Taxonomy
Speciality
Code
Description
License number
State
171400000X
Health & Wellness Coach
Primary
A-3683245
ID
2255A2300X
Athletic Trainer
AT-494
ID
Other
Enumeration date
05/28/2009
Last updated
06/12/2025
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