Provider Demographics
NPI:1821639204
Name:DIAS, NOVLETTE P
Entity Type:Individual
Prefix:MRS
First Name:NOVLETTE
Middle Name:P
Last Name:DIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:NOVLETTE
Other - Middle Name:
Other - Last Name:PAIGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:99 GOODYEAR ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-1010
Mailing Address - Country:US
Mailing Address - Phone:860-712-6698
Mailing Address - Fax:
Practice Address - Street 1:75 N MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-3468
Practice Address - Country:US
Practice Address - Phone:860-712-6698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT123936163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation