Provider Demographics
NPI:1356000483
Name:LEVERING, CHARLOTTA JOSEFINE OVESDOTTER (RD/RDN, CDN)
Entity Type:Individual
Prefix:
First Name:CHARLOTTA
Middle Name:JOSEFINE OVESDOTTER
Last Name:LEVERING
Suffix:
Gender:F
Credentials:RD/RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 E BROADWAY APT 4P
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:410 E BROADWAY APT 4P
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4406
Practice Address - Country:US
Practice Address - Phone:201-280-2422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010757-01133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered