Provider Demographics
NPI:1669837852
Name:LEVIEGE, INDIA (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:
First Name:INDIA
Middle Name:
Last Name:LEVIEGE
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 OLD SEWARD HWY STE 205
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-1473
Mailing Address - Country:US
Mailing Address - Phone:907-764-0103
Mailing Address - Fax:
Practice Address - Street 1:5700 OLD SEWARD HWY STE 205
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1473
Practice Address - Country:US
Practice Address - Phone:907-764-0103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKHADH180381744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management