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Individual

MARY E NOVOTNY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
3535 N BELL SCHOOL RD, ROCKFORD, IL 61114-6624
(779) 696-9400
(779) 696-9334
Mailing address
PO BOX 78866, MILWAUKEE, WI 53278-8866
(779) 696-7150
(779) 696-7342

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041-359227
IL
363LG0600X
Gerontology Nurse Practitioner
Primary
209-013360
IL

Other

Enumeration date
06/19/2015
Last updated
12/17/2024
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