Provider Demographics
NPI:1558619536
Name:LEVANDUSKI, LAUREN ANN (NP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANN
Last Name:LEVANDUSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ANN
Other - Last Name:CHIPPONERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAUREN ANN CHIPPONER
Mailing Address - Street 1:47601 GRAND RIVER AVE STE B229
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1257
Mailing Address - Country:US
Mailing Address - Phone:248-465-4290
Mailing Address - Fax:248-465-4883
Practice Address - Street 1:47601 GRAND RIVER AVE STE B229
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1257
Practice Address - Country:US
Practice Address - Phone:248-465-4290
Practice Address - Fax:248-465-4883
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9383489363LF0000X
MI4704316428363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1532143Medicaid
MI1558619536Medicaid
TN6000643OtherBLUE CROSS-BLUE SHIELD
TNP01309140OtherRR MEDICARE
TN10350I1886Medicare PIN