MEDICARE: MS. ANDREA NOVAK C.R.N.A.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	557827	NY
2	367500000X	Certified Registered Nurse Anesthetist	R195339	MD
3	367500000X	Certified Registered Nurse Anesthetist	RN967093	DC
4	367500000X	Certified Registered Nurse Anesthetist	COA13154	OH

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1093791782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA NOVAK C.R.N.A.

Provider Business Mailing Address
First Line	:	18697 BAGLEY RD
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-3417
Country	:	US
Telephone Number	:	440-816-6246
Fax Number	:	440-816-6263

Provider Business Practice Location Address
First Line	:	18697 BAGLEY RD
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-3417
Country	:	US
Telephone Number	:	440-816-6246
Fax Number	:	440-816-6246

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	08/24/2020

18697 BAGLEY ROAD
MIDDLEBURG HEIGHTS, OH
44130-3417

Practice Phone: 440-816-8770
Practice Fax: 440-816-8806

18697 BAGLEY RD
MIDDLEBURG HEIGHTS, OH
44130-3417