Provider Demographics
NPI:1851584437
Name:LEVICK, CYNTHIA LOUISE (FNP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LOUISE
Last Name:LEVICK
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 1:446 RIPLEY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:ME
Mailing Address - Zip Code:04971-7524
Mailing Address - Country:US
Mailing Address - Phone:207-277-3055
Mailing Address - Fax:
Practice Address - Street 1:29 CHURCH ST
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:ME
Practice Address - Zip Code:04930-1320
Practice Address - Country:US
Practice Address - Phone:207-924-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP091054363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME434979199Medicaid
MEC22673OtherRAILROAD MEDICARE
ME001469401OtherMEDICARE PTAN