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NPI Code Detail

MEDICARE: MA ELLEN NOVICIO APRN

MEDICARE: MA ELLEN NOVICIO APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerAP110326TX

General Provider Information

NPI Number : 1578503231
Entity Type Code : Individual
Provider Name (Legal Business Name) : MA ELLEN NOVICIO APRN
Provider Business Mailing Address
First Line : PO BOX 2129
Second Line :
City : ODESSA
State : TX
Zip : 79760-2129
Country : US
Telephone Number : 432-337-3117
Fax Number : 432-640-2868
Provider Business Practice Location Address
First Line : 720 GOLDER AVE
Second Line :
City : ODESSA
State : TX
Zip : 79761-4442
Country : US
Telephone Number : 432-337-3117
Fax Number : 432-640-2868
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2006
Last Update Date : 04/02/2020

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Directions to “ MA ELLEN NOVICIO APRN” Practice Location

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