Provider Demographics
NPI:1053082339
Name:LEVINSON, GAYLE (NP)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:LEVINSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 PASTILLE LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-2830
Mailing Address - Country:US
Mailing Address - Phone:919-395-4765
Mailing Address - Fax:
Practice Address - Street 1:1300 WESTERN BLVD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27699-4285
Practice Address - Country:US
Practice Address - Phone:919-395-4765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-25
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC270509163W00000X
NC5015881363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5015881OtherNURSE PRACTITIONER LICENSE
NC000025643259OtherDRIVERS LICENSE