MEDICARE: LOIS K NOVIKOFF MSN

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
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	RN 135150	OH

General Provider Information

NPI Number	:	1629172648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOIS K NOVIKOFF MSN

Provider Business Mailing Address
First Line	:	4035 CHARLTON RD
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-2714
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	54 S STATE ST
Second Line	:
City	:	PAINESVILLE
State	:	OH
Zip	:	44077-3445
Country	:	US
Telephone Number	:	440-357-6740
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	07/08/2007

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