Provider Demographics
NPI:1255623310
Name:NOVAK, JULAYNE C (RNC)
Entity type:Individual
Prefix:
First Name:JULAYNE
Middle Name:C
Last Name:NOVAK
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S 30TH ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-5594
Mailing Address - Country:US
Mailing Address - Phone:920-684-1332
Mailing Address - Fax:920-684-3651
Practice Address - Street 1:1100 S 30TH ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-5594
Practice Address - Country:US
Practice Address - Phone:920-684-1332
Practice Address - Fax:920-684-3651
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI65203-30261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42007500Medicaid