Provider Demographics
NPI:1073628376
Name:CERKOVITZ, LEONA L (FNP)
Entity Type:Individual
Prefix:
First Name:LEONA
Middle Name:L
Last Name:CERKOVITZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 PARK STREET
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04473-4602
Mailing Address - Country:US
Mailing Address - Phone:207-866-9025
Mailing Address - Fax:207-866-2207
Practice Address - Street 1:192 PARK STREET
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04473-4602
Practice Address - Country:US
Practice Address - Phone:207-866-9025
Practice Address - Fax:207-866-2207
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME038985363LF0000X
MECNP81388363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MENP3823Medicare ID - Type Unspecified
MEP62320Medicare UPIN