Provider Demographics
NPI:1023651304
Name:NOVAK, JESSICA LYNN (CRNA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:NOVAK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:KARL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:731 S DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-3717
Mailing Address - Country:US
Mailing Address - Phone:201-248-1689
Mailing Address - Fax:
Practice Address - Street 1:2233 STATE ROUTE 86
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-5644
Practice Address - Country:US
Practice Address - Phone:518-891-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-19
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT103163453102163W00000X
NY786233367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse