Basic Information
| Provider Information | |||||||||
| NPI: | 1205591443 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOVAK | ||||||||
| FirstName: | ALEXIS | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5112 WHISPERING PINES LN | ||||||||
| Address2: | |||||||||
| City: | MURRYSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156688024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7247713484 | ||||||||
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| Practice Location | |||||||||
| Address1: | 232 W 25TH ST | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165440002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144525354 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2021 | ||||||||
| LastUpdateDate: | 11/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.