Provider Demographics
NPI:1689939746
Name:NOVAK, AMANDA BRUCE (WHNP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:BRUCE
Last Name:NOVAK
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:BRUCE
Other - Last Name:ESSARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP
Mailing Address - Street 1:1049 NORTH PINE ROAD
Mailing Address - Street 2:HARDTNER MEDICAL CENTER
Mailing Address - City:OLLA
Mailing Address - State:LA
Mailing Address - Zip Code:71465
Mailing Address - Country:US
Mailing Address - Phone:318-495-3175
Mailing Address - Fax:318-495-0771
Practice Address - Street 1:1049 NORTH PINE ROAD
Practice Address - Street 2:HARDTNER MEDICAL CENTER
Practice Address - City:OLLA
Practice Address - State:LA
Practice Address - Zip Code:71465
Practice Address - Country:US
Practice Address - Phone:318-495-3175
Practice Address - Fax:318-495-0771
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06941363LX0001X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology