Healthcare Provider Details

I. General information

NPI: 1487823092
Provider Name (Legal Business Name): ROBERT F NOVELL RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 ALTAIR DR
COLORADO SPRINGS CO
80905-7167
US

IV. Provider business mailing address

PO BOX 938
ROWLETT TX
75030-0938
US

V. Phone/Fax

Practice location:
  • Phone: 214-227-2457
  • Fax: 214-764-0880
Mailing address:
  • Phone: 214-227-2457
  • Fax: 214-764-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1630968
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number687333
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number748850
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number1630968
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: