MEDICARE: KATHERINE M NOVOTNY NP-C

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	COA09386NP	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1477671642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE M NOVOTNY NP-C

Provider Business Mailing Address
First Line	:	7580 AUBURN RD
Second Line	:	STE 301
City	:	PAINESVILLE
State	:	OH
Zip	:	44077-9618
Country	:	US
Telephone Number	:	440-352-7546
Fax Number	:	440-352-5260

Provider Business Practice Location Address
First Line	:	7580 AUBURN RD
Second Line	:	SUITE 301
City	:	CONCORD TWP
State	:	OH
Zip	:	44077-9615
Country	:	US
Telephone Number	:	440-352-7546
Fax Number	:	440-352-5260

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	05/12/2016

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