Provider Demographics
NPI:1619641883
Name:LEVINA, ANNA (FNP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:LEVINA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 WEILAND RD UNIT 100
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-7053
Mailing Address - Country:US
Mailing Address - Phone:847-947-8444
Mailing Address - Fax:847-947-8435
Practice Address - Street 1:975 WEILAND RD UNIT 100
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-7053
Practice Address - Country:US
Practice Address - Phone:847-947-8444
Practice Address - Fax:847-947-8435
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021776363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209021776OtherLICENSE