Provider Demographics
NPI:1093297434
Name:LEVIN, JACQUELINE (RN, MS)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:LEVIN
Suffix:
Gender:F
Credentials:RN, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 877
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368
Mailing Address - Country:US
Mailing Address - Phone:206-304-7703
Mailing Address - Fax:
Practice Address - Street 1:234 POND ROAD
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368
Practice Address - Country:US
Practice Address - Phone:206-304-7703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-02
Last Update Date:2018-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60022041364SH1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SH1100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHolistic