Healthcare Provider Details

I. General information

NPI: 1669936233
Provider Name (Legal Business Name): MICHELA NOVELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 ROGER BROOKE DR
FORT SAM HOUSTON TX
78234-4504
US

IV. Provider business mailing address

5340 WALZEM RD STE 5340
WINDCREST TX
78218-2123
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-0305
  • Fax: 210-599-8508
Mailing address:
  • Phone: 210-653-8085
  • Fax: 210-599-8508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP140333
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: