Healthcare Provider Details

I. General information

NPI: 1679105613
Provider Name (Legal Business Name): MONICA NOVAK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 08/02/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21475 RIDGETOP CIR STE 150
STERLING VA
20166-6580
US

IV. Provider business mailing address

36505 SPRING POND LN
PURCELLVILLE VA
20132-9002
US

V. Phone/Fax

Practice location:
  • Phone: 703-444-5000
  • Fax: 703-444-4999
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: