Provider Demographics
NPI:1639675432
Name:LEVON, PRECIOUS BIANCA (FNP-C)
Entity Type:Individual
Prefix:
First Name:PRECIOUS
Middle Name:BIANCA
Last Name:LEVON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43472
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-0472
Mailing Address - Country:US
Mailing Address - Phone:773-961-4008
Mailing Address - Fax:
Practice Address - Street 1:10600 SOUTHWEST HWY APT 303A
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-3809
Practice Address - Country:US
Practice Address - Phone:773-961-4008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily