Provider Demographics
NPI:1083918833
Name:LEVITZ, ABBY MARIE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:MARIE
Last Name:LEVITZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 N DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:IN
Mailing Address - Zip Code:46761-1147
Mailing Address - Country:US
Mailing Address - Phone:260-463-2468
Mailing Address - Fax:260-463-4237
Practice Address - Street 1:2120 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:IN
Practice Address - Zip Code:46761-1147
Practice Address - Country:US
Practice Address - Phone:260-463-2468
Practice Address - Fax:260-463-4237
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003495A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400041556Medicare PIN