MEDICARE: MARCIA G NOVAK CRNA

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	367500000X	Certified Registered Nurse Anesthetist	28393	TX

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	82435U	OTHER	TX	BC/BS

General Provider Information

NPI Number	:	1528041993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIA G NOVAK CRNA

Provider Business Mailing Address
First Line	:	7900 FM 1826
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78737-1407
Country	:	US
Telephone Number	:	512-324-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	7900 FM 1826
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78737-1407
Country	:	US
Telephone Number	:	512-324-7000
Fax Number	:

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	07/21/2022

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