Active NPI
Danielle Novack
- Specialist
- Saint Paul, MN
National Provider Identifier
1528997632
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 1004636
- Practice address
- 451 Edmund Ave
Saint Paul, MN 55103-1608 - Phone
- (507) 330-3913
- NPI assigned
- May 15, 2026
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 1004636 | MN | Primary |
Addresses
Primary practice location
451 Edmund Ave
Saint Paul, MN 55103-1608
Mailing address
451 Edmund Ave
Saint Paul, MN 55103-1608
Phone (507) 330-3913
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1004636 | MN | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1778803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1778803200000",
"number": "1528997632",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "451 EDMUND AVE",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551031608",
"telephone_number": "507-330-3913"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "451 EDMUND AVE",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551031608",
"telephone_number": "507-330-3913"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOVACK",
"first_name": "DANIELLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2026-05-15",
"last_updated": "2026-05-15",
"certification_date": "2026-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist",
"state": "MN",
"license": "1004636",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.