Healthcare Provider Details

I. General information

NPI: 1659811404
Provider Name (Legal Business Name): KARA NOVAK CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S UNION BLVD
COLORADO SPRINGS CO
80910-3184
US

IV. Provider business mailing address

PO BOX 46
VICTOR CO
80860-0046
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-5700
  • Fax:
Mailing address:
  • Phone: 210-563-6321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAPN0992432-CNM
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: