Healthcare Provider Details

I. General information

NPI: 1548052566
Provider Name (Legal Business Name): THERESA NOVATNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9089 S PECOS RD STE 3600
HENDERSON NV
89074-7186
US

IV. Provider business mailing address

9089 S PECOS RD STE 3600
HENDERSON NV
89074-7186
US

V. Phone/Fax

Practice location:
  • Phone: 702-680-1526
  • Fax:
Mailing address:
  • Phone: 702-680-1526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number25-423008
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: