Healthcare Provider Details

I. General information

NPI: 1225003957
Provider Name (Legal Business Name): PAULA NOVELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 05/24/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N EAST AVE IMAGING SERVICES H.F. ALLEGIANCE HEALTH
JACKSON MI
49201-1753
US

IV. Provider business mailing address

2800 SPRING ARBOR RD STE 102 PO BOX 905
JACKSON MI
49203-3895
US

V. Phone/Fax

Practice location:
  • Phone: 517-783-2612
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301090333
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: