Provider Demographics
NPI:1669936233
Name:NOVELLI, MICHELA
Entity type:Individual
Prefix:
First Name:MICHELA
Middle Name:
Last Name:NOVELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5340 WALZEM RD STE 5340
Mailing Address - Street 2:
Mailing Address - City:WINDCREST
Mailing Address - State:TX
Mailing Address - Zip Code:78218-2123
Mailing Address - Country:US
Mailing Address - Phone:210-653-8085
Mailing Address - Fax:210-599-8508
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-0305
Practice Address - Fax:210-599-8508
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140333363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily