Provider Demographics
NPI:1003293010
Name:MOONEY-LEVIN, MEREDITH (CRNA)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:MOONEY-LEVIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 W CORNELIA AVE
Mailing Address - Street 2:APT 104
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1596
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:736 N 38TH ST UNIT C
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-1655
Practice Address - Country:US
Practice Address - Phone:267-322-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR213871163W00000X
DEL1-0043499163W00000X
PARN627638163W00000X, 367500000X
NJ26NR16665000163W00000X
IL041429932163W00000X
IL209013035367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse