Provider Demographics
NPI:1609610880
Name:NOVAK, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:NOVAK
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 1:2002 GARDEN PARK DR APT 4
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-3802
Mailing Address - Country:US
Mailing Address - Phone:260-202-5161
Mailing Address - Fax:
Practice Address - Street 1:2002 GARDEN PARK DR APT 4
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-3802
Practice Address - Country:US
Practice Address - Phone:260-202-5161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach