Healthcare Provider Details

I. General information

NPI: 1588125983
Provider Name (Legal Business Name): AVREY ANN NOVAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 BOLIVAR ST
NEW ORLEANS LA
70112-7021
US

IV. Provider business mailing address

433 BOLIVAR ST
NEW ORLEANS LA
70112-7021
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-4808
  • Fax:
Mailing address:
  • Phone: 504-568-4808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number347767
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: