Provider Demographics
NPI:1942211008
Name:LEVITAN, LESLIE LEZELL (NP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:LEZELL
Last Name:LEVITAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CENTENNIAL DR
Mailing Address - Street 2:EAST ENTRANCE
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7900
Mailing Address - Country:US
Mailing Address - Phone:978-826-7230
Mailing Address - Fax:978-826-7237
Practice Address - Street 1:10 CENTENNIAL DR
Practice Address - Street 2:EAST ENTRANCE
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7900
Practice Address - Country:US
Practice Address - Phone:978-826-7230
Practice Address - Fax:978-826-7237
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA232255363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA274394OtherHARVARD PILGRIM
MANP4430OtherBLUECROSS/BLUESHIELD
MA071164OtherTUFTS
MA0486537OtherAETNA/US HEALTHCARE
MD7619618001OtherCIGNA
MA071164OtherTUFTS
MAQ07944Medicare UPIN