Provider Demographics
NPI:1144031949
Name:NOVOTNY, LAUREL J
Entity type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:J
Last Name:NOVOTNY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:NOVOTNY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1706 N 130TH AVENUE CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-3627
Mailing Address - Country:US
Mailing Address - Phone:402-980-9835
Mailing Address - Fax:
Practice Address - Street 1:1706 N 130TH AVENUE CIR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-3627
Practice Address - Country:US
Practice Address - Phone:402-980-9835
Practice Address - Fax:402-980-9835
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider