Provider Demographics
NPI:1447706932
Name:NOVITA, FNU
Entity type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:NOVITA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4273 STROMFORD WAY
Mailing Address - Street 2:
Mailing Address - City:MATHER
Mailing Address - State:CA
Mailing Address - Zip Code:95655-3003
Mailing Address - Country:US
Mailing Address - Phone:916-812-0151
Mailing Address - Fax:
Practice Address - Street 1:4273 STROMFORD WAY
Practice Address - Street 2:
Practice Address - City:MATHER
Practice Address - State:CA
Practice Address - Zip Code:95655-3003
Practice Address - Country:US
Practice Address - Phone:916-812-0151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN233516164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse