Provider Demographics
NPI:1023068046
Name:LEVINE, RENEE SIMCOE (CRNA)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:SIMCOE
Last Name:LEVINE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:A
Other - Last Name:SIMCOE-MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:500 LYTTLETON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-4161
Mailing Address - Country:US
Mailing Address - Phone:704-277-3468
Mailing Address - Fax:
Practice Address - Street 1:1000 BLYTHE BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5812
Practice Address - Country:US
Practice Address - Phone:704-355-5925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC072082367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8053314Medicaid
SCNAN544Medicaid
NC8052146Medicaid
NC8053314Medicaid