Provider Demographics
NPI:1780750240
Name:NOVAK, ASHA (RN, LAC)
Entity type:Individual
Prefix:
First Name:ASHA
Middle Name:
Last Name:NOVAK
Suffix:
Gender:F
Credentials:RN, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2082
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98041-2082
Mailing Address - Country:US
Mailing Address - Phone:206-498-1545
Mailing Address - Fax:425-402-8171
Practice Address - Street 1:9631 FIRDALE AVE
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-6519
Practice Address - Country:US
Practice Address - Phone:206-498-1545
Practice Address - Fax:425-402-8171
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2193171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist