Provider Demographics
NPI:1841533924
Name:NOVACK, HOLLY GRACE
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:GRACE
Last Name:NOVACK
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 1:6620 LAWLOR CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-1961
Mailing Address - Country:US
Mailing Address - Phone:206-225-4013
Mailing Address - Fax:
Practice Address - Street 1:6620 LAWLOR CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-1961
Practice Address - Country:US
Practice Address - Phone:206-225-4013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKML125067207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology