Provider Demographics
NPI:1578045134
Name:NOVAK, WENDY DIANE (RN)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:DIANE
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 1:214 W LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37148-1641
Mailing Address - Country:US
Mailing Address - Phone:615-406-0662
Mailing Address - Fax:615-325-5549
Practice Address - Street 1:214 W LONGVIEW DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TN
Practice Address - Zip Code:37148-1641
Practice Address - Country:US
Practice Address - Phone:615-406-0662
Practice Address - Fax:615-325-5549
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN68434163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN163WC1500XOtherSUMNER COUNTY HEALTH DEPARTMENT