Provider Demographics
NPI:1548067937
Name:NOVAK, MICHELLE ANTOINETTE (CNA HHA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANTOINETTE
Last Name:NOVAK
Suffix:
Gender:F
Credentials:CNA HHA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:A
Other - Last Name:SEVERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA HHA
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:NE
Mailing Address - Zip Code:68019-0091
Mailing Address - Country:US
Mailing Address - Phone:402-260-9381
Mailing Address - Fax:
Practice Address - Street 1:320 NORTH BURT STREET
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:NE
Practice Address - Zip Code:68019
Practice Address - Country:US
Practice Address - Phone:402-260-9381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE41221376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide