Provider Demographics
NPI:1689270738
Name:NOVAK, LEEANN JEAN
Entity Type:Individual
Prefix:
First Name:LEEANN
Middle Name:JEAN
Last Name:NOVAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3179 43RD AVE S
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6189
Mailing Address - Country:US
Mailing Address - Phone:701-330-4198
Mailing Address - Fax:
Practice Address - Street 1:3174 36TH AVE S APT 8
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-3538
Practice Address - Country:US
Practice Address - Phone:218-791-3365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant