Individual
ETHAN GRANT NOVACINSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3200 GRAND AVE, DES MOINES, IA 50312-4104
(515) 271-1569
Mailing address
9558 IRONWOOD DR, SAINT JOSEPH, MN 56374-8720
(320) 223-9732
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
14620
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/07/2022
Last updated
09/27/2023
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