Provider Demographics
NPI:1083873707
Name:NOVAK, GLADYS ELAINE (MSOM)
Entity Type:Individual
Prefix:MS
First Name:GLADYS
Middle Name:ELAINE
Last Name:NOVAK
Suffix:
Gender:F
Credentials:MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8517 EXCELSIOR DR STE 304
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-2910
Mailing Address - Country:US
Mailing Address - Phone:608-833-1688
Mailing Address - Fax:608-833-1683
Practice Address - Street 1:8517 EXCELSIOR DR STE 304
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-2910
Practice Address - Country:US
Practice Address - Phone:608-833-1688
Practice Address - Fax:608-833-1683
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI509-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist