Provider Demographics
NPI:1578645206
Name:NOVOA, CARMEN MARIA (CRNA)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:MARIA
Last Name:NOVOA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 FAIRFIELD ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-1823
Mailing Address - Country:US
Mailing Address - Phone:718-869-7212
Mailing Address - Fax:
Practice Address - Street 1:89 FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1823
Practice Address - Country:US
Practice Address - Phone:718-869-7212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant