Provider Demographics
NPI:1003385048
Name:NOVAK, KATHLEEN (RN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:NOVAK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11101 ALLENHURST BLVD E
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-6619
Mailing Address - Country:US
Mailing Address - Phone:513-252-3853
Mailing Address - Fax:
Practice Address - Street 1:10725 OLD POND DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45249-3532
Practice Address - Country:US
Practice Address - Phone:513-520-9639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.328998163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics