Basic Information
| Provider Information | |||||||||
| NPI: | 1679752836 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NOVAK | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | BARRACCA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN,MA,CHTP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 GOSHEN HTS | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 062492405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606426428 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 326 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | NORWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063602740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608898331 | ||||||||
| FaxNumber: | 8608853562 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2007 | ||||||||
| LastUpdateDate: | 10/24/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | E34061 | CT | Y | Nursing Service Providers | Registered Nurse |
No ID Information.