Provider Demographics
NPI:1821122599
Name:LEVY-LACHANCE, AUDREY IRENE (PA-C)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:IRENE
Last Name:LEVY-LACHANCE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ENGLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-5221
Mailing Address - Country:US
Mailing Address - Phone:401-823-1889
Mailing Address - Fax:401-272-9500
Practice Address - Street 1:935 JEFFERSON BLVD
Practice Address - Street 2:SUITE 1002
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2237
Practice Address - Country:US
Practice Address - Phone:401-490-7530
Practice Address - Fax:401-490-7534
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00052363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant