Individual
JESSICA ANNE NOVACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
875 N WOODBRIDGE DR, BLOOMINGTON, IN 47408-2784
(260) 341-3706
Mailing address
875 N WOODBRIDGE DR, BLOOMINGTON, IN 47408-2784
(260) 341-3706
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36002171A
IN
Other
Enumeration date
03/23/2015
Last updated
03/23/2015
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