Provider Demographics
NPI:1407826712
Name:LEVINE, WM (FNP)
Entity Type:Individual
Prefix:
First Name:WM
Middle Name:
Last Name:LEVINE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-2211
Mailing Address - Country:US
Mailing Address - Phone:413-774-4014
Mailing Address - Fax:413-774-7824
Practice Address - Street 1:160 ELM ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2211
Practice Address - Country:US
Practice Address - Phone:413-774-4014
Practice Address - Fax:413-774-7824
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216071363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1301128Medicaid
S87056Medicare UPIN
MA1301128Medicaid