Provider Demographics
NPI:1992065551
Name:KOVELAN, NAOMI JEAN
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:JEAN
Last Name:KOVELAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 532
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-0532
Mailing Address - Country:US
Mailing Address - Phone:608-647-8700
Mailing Address - Fax:
Practice Address - Street 1:172 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-2229
Practice Address - Country:US
Practice Address - Phone:608-647-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI432-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist