Provider Demographics
NPI:1265521173
Name:NOVAK, VALERIE (NP)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:NOVAK
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:DEPT 557
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-0557
Mailing Address - Country:US
Mailing Address - Phone:303-467-4155
Mailing Address - Fax:303-467-4156
Practice Address - Street 1:500 DISCOVERY PKWY
Practice Address - Street 2:#100
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027-8639
Practice Address - Country:US
Practice Address - Phone:303-403-7800
Practice Address - Fax:303-403-7801
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO110102163W00000X
COAPN.0001788363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO3779076Medicaid
COC808805Medicare PIN