Provider Demographics
NPI:1194982249
Name:BRADY NOVAK, THERESA CLAIRE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:CLAIRE
Last Name:BRADY NOVAK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CATHOLIC UNIVERSITY STUDENT
Mailing Address - Street 2:620 MICHIGAN AVE
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20064-0001
Mailing Address - Country:US
Mailing Address - Phone:202-319-5744
Mailing Address - Fax:202-319-4793
Practice Address - Street 1:CATHOLIC UNIVERSITY STUDENT
Practice Address - Street 2:620 MICHIGAN AVE
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20064-0001
Practice Address - Country:US
Practice Address - Phone:202-319-5744
Practice Address - Fax:202-319-4793
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC760033262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCC86579Medicare UPIN
DC174203Medicare PIN