Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 0401415601 | VA |
N | 1223G0001X | General Practice | DS040917 | PA |
N | 213EG0000X | General Practice | DS040917 | PA |
NPI | 1134571086 |
---|---|
Provider Name | Dr. Jennifer Jean Novak |
First Address | Manassas, VA 20112-3000 |
Second Address | Alexandria, VA 22309-2344 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2016 |
Last Update Date | 13/10/2017 |