Provider Demographics
NPI:1508610171
Name:NOVAK, ALEXIS (RN)
Entity Type:Individual
Prefix:
First Name:ALEXIS
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 1:2605 GREENLAWN DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-4362
Mailing Address - Country:US
Mailing Address - Phone:734-417-3584
Mailing Address - Fax:
Practice Address - Street 1:2605 GREENLAWN DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-4362
Practice Address - Country:US
Practice Address - Phone:734-417-3584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH474700163W00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide