Provider Demographics
NPI:1952487662
Name:LEVITCH, ELYSE SUZANNE (ARNP)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:SUZANNE
Last Name:LEVITCH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:LEVITCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:324S SHERMAN ST A1
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1461
Mailing Address - Country:US
Mailing Address - Phone:509-624-1184
Mailing Address - Fax:509-241-1426
Practice Address - Street 1:823 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2850
Practice Address - Country:US
Practice Address - Phone:509-838-3655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005648363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP27560Medicare UPIN
WA8859564Medicare PIN