Healthcare Provider Details

I. General information

NPI: 1689939746
Provider Name (Legal Business Name): AMANDA BRUCE NOVAK WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA BRUCE ESSARY WHNP

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 NORTH PINE ROAD HARDTNER MEDICAL CENTER
OLLA LA
71465
US

IV. Provider business mailing address

1049 NORTH PINE ROAD HARDTNER MEDICAL CENTER
OLLA LA
71465
US

V. Phone/Fax

Practice location:
  • Phone: 318-495-3175
  • Fax: 318-495-0771
Mailing address:
  • Phone: 318-495-3175
  • Fax: 318-495-0771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP06941
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP06941
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: