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Nicole Novak

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

10625 W North Ave, Wauwatosa, WI 53226-2315

PECOS Enrollment

Based on the most recent information from CMS, provider Nicole Novak is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1811424609
Provider Type
Individual
Full Name
Novak, Nicole
Title
Mrs.
Credential
PA-C

Gender
Female
Sole Proprietor
No
Enumeration Date
5/11/2017
Last Updated
5/11/2017

Contact Information

Practice Location

10625 W North Ave, Wauwatosa, WI 53226-2315

(414) 877-5350

Unlisted Fax

Mailing Location

10625 W North Ave, Wauwatosa, WI 53226-2315

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 4009-23 Wisconsin

Nicole Novak

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Beyer, Adam

Kortbein, Eric

Loftis, Patrick

Hayes, Anna

Gangl, Joshua

Forbord, Nicole Elizabeth

Wilkins, Karly D

Mcdonald, Mark C

Krueger, Kathryn E

Cortez, Olivia