Provider Demographics
NPI:1750460366
Name:NOVAK, CONNIE J (MD)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:J
Last Name:NOVAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:J
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:250 N COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68434-2248
Mailing Address - Country:US
Mailing Address - Phone:402-646-4622
Mailing Address - Fax:402-646-4635
Practice Address - Street 1:250 N COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-2248
Practice Address - Country:US
Practice Address - Phone:402-646-4622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21478207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE0102571OtherUNITEDHEALTHCARE
NE03263OtherBCBS OF NEBRASKA
NE11996OtherMIDLANDS CHOICE
NE03263OtherBCBS OF NEBRASKA
NEG72024Medicare UPIN