Provider Demographics
NPI:1487606463
Name:NOVAK, TERESA L (PA)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:L
Last Name:NOVAK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:TERESA
Other - Middle Name:M
Other - Last Name:NOVAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:7441 O ST
Mailing Address - Street 2:STE 400
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2468
Mailing Address - Country:US
Mailing Address - Phone:402-488-7400
Mailing Address - Fax:
Practice Address - Street 1:7441 O ST
Practice Address - Street 2:STE 400
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2468
Practice Address - Country:US
Practice Address - Phone:402-488-7400
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE466363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S33296Medicare UPIN
NE268291Medicare ID - Type UnspecifiedMC-ASHLAND