Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | CNP 5012 | MN |
Y | 363LG0600X | Nurse Practitioner - Gerontology | CNP 5012 | MN |
NPI | 1023557352 |
---|---|
Provider Name | Jennifer Novak |
First Address | Minneapolis, MN 55425-4516 |
Second Address | Maplewood, MN 55109-2707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2017 |
Last Update Date | 25/02/2020 |