Healthcare Provider Details

I. General information

NPI: 1508634114
Provider Name (Legal Business Name): MERCEDEH NOVAK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4423 W FLAMINGO RD
LAS VEGAS NV
89103-3703
US

IV. Provider business mailing address

398 DISCOVERY CT
HENDERSON NV
89014-4586
US

V. Phone/Fax

Practice location:
  • Phone: 702-458-1137
  • Fax: 702-458-1423
Mailing address:
  • Phone: 702-860-8134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN58955
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: