Basic Information
Provider Information | |||||||||
NPI: | 1780183129 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NOVAK | ||||||||
FirstName: | VIVIAN | ||||||||
MiddleName: | C | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | APRN AGACNP-BC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1155 MILL ST | ||||||||
Address2: | MS M14 | ||||||||
City: | RENO | ||||||||
State: | NV | ||||||||
PostalCode: | 895021576 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7759824876 | ||||||||
FaxNumber: | 7759824196 | ||||||||
Practice Location | |||||||||
Address1: | 10120 S EASTERN AVE STE 250 | ||||||||
Address2: |   | ||||||||
City: | HENDERSON | ||||||||
State: | NV | ||||||||
PostalCode: | 890523951 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7024836200 | ||||||||
FaxNumber: | 7024836202 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/12/2018 | ||||||||
LastUpdateDate: | 05/03/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/03/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | APRN002795 | NV | N |   | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 163WC0200X | RN76135 | NV | N |   | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 363LA2200X | APRN002795 | NV | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LG0600X | APRN002795 | NV | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363LA2100X | APRN002795 | NV | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.