Healthcare Provider Details

I. General information

NPI: 1952332447
Provider Name (Legal Business Name): JANELLE L NOVICK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N OCOTILLO DR
APACHE JUNCTION AZ
85220-3740
US

IV. Provider business mailing address

PO BOX 3160
APACHE JUNCTION AZ
85217-3160
US

V. Phone/Fax

Practice location:
  • Phone: 480-983-0571
  • Fax: 480-983-0896
Mailing address:
  • Phone: 480-288-5328
  • Fax: 480-288-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP1829
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: