| Doctor Name: | AMANDA J NOVACK |
| NPI Number: | 1316100092 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | E-6796 |
| Business Practice Address: | 4301 W Markham St Slot #783 Little Rock, AR - 722057101 |
| Business Phone Number: | 5019400110 |
| Business Fax Number: | |
| Mailing Address: | 4904 Lafayette Ave, LITTLE ROCK |
| State: | AR |
| Postal Code: | 72205 |
| Phone Number: | 5019400110 |
| Fax Number: | |
| NPI Enumeration Date: | 07/03/2008 |
| NPI Last Update Date: | 02/18/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | E-6796 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |