Provider Demographics
NPI:1316908106
Name:WAGNER NOVAK, JOANN M (NP)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:M
Last Name:WAGNER NOVAK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 W NEWHAVEN CIR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1052
Mailing Address - Country:US
Mailing Address - Phone:608-609-9991
Mailing Address - Fax:
Practice Address - Street 1:21 W NEWHAVEN CIR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1052
Practice Address - Country:US
Practice Address - Phone:608-609-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1207-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily