Organization
NOVUS MICHIGAN PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARRIE VAUGHAN (PRACTICE MANAGER)
(404) 419-0237
Entity
Organization
Contact information
Practice address
805 S OAKLAND ST, SAINT JOHNS, MI 48879-2253
(989) 224-6881
Mailing address
PO BOX 12766, PENSACOLA, FL 32591-2766
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Enumeration date
08/26/2021
Last updated
02/23/2022
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