Provider Demographics
NPI:1821628967
Name:LEVANWAY, JOANNE ALISON (RDN LD)
Entity Type:Individual
Prefix:MISS
First Name:JOANNE
Middle Name:ALISON
Last Name:LEVANWAY
Suffix:
Gender:F
Credentials:RDN LD
Other - Prefix:MS
Other - First Name:JOANNE
Other - Middle Name:ALISON
Other - Last Name:LEVANWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LD
Mailing Address - Street 1:13701 HIDDEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-7025
Mailing Address - Country:US
Mailing Address - Phone:228-860-6058
Mailing Address - Fax:228-832-1294
Practice Address - Street 1:13701 HIDDEN OAKS DR
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-7025
Practice Address - Country:US
Practice Address - Phone:228-860-6058
Practice Address - Fax:228-832-1294
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD1170133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty