Provider Demographics
NPI:1922192665
Name:NOVITOVIC, PENNY B (NP)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:B
Last Name:NOVITOVIC
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 W 9TH AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-7247
Mailing Address - Country:US
Mailing Address - Phone:920-223-3190
Mailing Address - Fax:920-223-3184
Practice Address - Street 1:2700 W 9TH AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7247
Practice Address - Country:US
Practice Address - Phone:920-223-3190
Practice Address - Fax:920-223-3184
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2884-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner