Provider Demographics
NPI:1174528509
Name:NOVAK, ALLEN (APRN)
Entity type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:
Last Name:NOVAK
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 HAILI ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2804
Mailing Address - Country:US
Mailing Address - Phone:808-934-9071
Mailing Address - Fax:808-934-9071
Practice Address - Street 1:122 HAILI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2804
Practice Address - Country:US
Practice Address - Phone:808-934-9071
Practice Address - Fax:808-934-9071
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-20223101YM0800X, 364SP0808X, 363LP0808X
HI422-91101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI544925Medicaid
HIH53165Medicare ID - Type Unspecified
HI544925Medicaid