License holder summary

TIA MARIE NOWACKI is a Board Of Medicine licensed to practice in Idaho. The address on file for TIA MARIE NOWACKI is 405 WEST VILLAGE LANE BOISE ID 83702. This licensed professional license is current. The license was granted 11/13/2013 and expired on 06/30/2017.

Idaho

Division of Occupational and Professional Licenses

TIA MARIE NOWACKI
Board Of Medicine
License number
AT-494
Date granted
11/13/2013
Date expires
06/30/2017
Class
Board Of Medicine
Status
Renewed
Address
405 WEST VILLAGE LANE BOISE ID 83702
idaholicensing.com
ID 48329597
LAST UPDATED 2026-04-02 09:32:59 UTC

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