Provider Demographics
NPI:1801105473
Name:NOVCHICH, AUDREY CELESTE (FNP)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:CELESTE
Last Name:NOVCHICH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:CELESTE
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:56 PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:HANSCOM AFB
Mailing Address - State:MA
Mailing Address - Zip Code:01731-2610
Mailing Address - Country:US
Mailing Address - Phone:919-394-1827
Mailing Address - Fax:
Practice Address - Street 1:246 MILL ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3310
Practice Address - Country:US
Practice Address - Phone:978-534-5114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2342133363LF0000X
VA0024172467363L00000X
NC5004901363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner