| Doctor Name: | ANDY NOVAK |
| NPI Number: | 1720231293 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MLT |
| License Number: | |
| Business Practice Address: | 230 E Main St Goldendale, WA - 986209015 |
| Business Phone Number: | 5092502710 |
| Business Fax Number: | |
| Mailing Address: | 230 E Main St, GOLDENDALE |
| State: | WA |
| Postal Code: | 986209015 |
| Phone Number: | 5092502710 |
| Fax Number: | |
| NPI Enumeration Date: | 10/28/2008 |
| NPI Last Update Date: | 10/28/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246RM2200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Technician, Pathology |
| Taxonomy Specialization: | Medical Laboratory |
| Taxonomy Definition: | |