Provider Demographics
NPI:1407097710
Name:LELEVICH, LOUISE ELAINE (NURSING)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:ELAINE
Last Name:LELEVICH
Suffix:
Gender:F
Credentials:NURSING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8414 SERAFINO CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-3922
Mailing Address - Country:US
Mailing Address - Phone:916-688-8968
Mailing Address - Fax:
Practice Address - Street 1:8414 SERAFINO CT
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-3922
Practice Address - Country:US
Practice Address - Phone:916-688-8968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN-72186164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse