Provider Demographics
NPI:1831392703
Name:NOVAK, DENISE MARIE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:MARIE
Last Name:NOVAK
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8030 SITIO CAUCHO
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-6954
Mailing Address - Country:US
Mailing Address - Phone:760-753-6357
Mailing Address - Fax:
Practice Address - Street 1:5555 GROSSMONT CENTER DR
Practice Address - Street 2:PRENATAL CLINIC
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3019
Practice Address - Country:US
Practice Address - Phone:619-740-4721
Practice Address - Fax:619-740-4971
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP15654363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP15654OtherFURNISHING NUMBER
CA653398OtherRN LICENSE NUMBER
CANP15654OtherNURSE PRACTITIONER NUMBER
CANP15654OtherNURSE PRACTITIONER NUMBER