Provider Demographics
NPI:1154672350
Name:LEVINE-WARD, AUDRIANNAH
Entity Type:Individual
Prefix:
First Name:AUDRIANNAH
Middle Name:
Last Name:LEVINE-WARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2732 SEMINARY AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-1531
Mailing Address - Country:US
Mailing Address - Phone:415-724-5504
Mailing Address - Fax:
Practice Address - Street 1:2728 DURANT AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1725
Practice Address - Country:US
Practice Address - Phone:510-841-9230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA94-1674865Medicaid