Provider Demographics
NPI:1265774855
Name:LEVY, JOAN ELLEN (RN, IBCLC, LCCE,)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:ELLEN
Last Name:LEVY
Suffix:
Gender:F
Credentials:RN, IBCLC, LCCE,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PONDEROSA PARK DR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6787
Mailing Address - Country:US
Mailing Address - Phone:919-556-9674
Mailing Address - Fax:
Practice Address - Street 1:10 PONDEROSA PARK DR
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6787
Practice Address - Country:US
Practice Address - Phone:919-556-9674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC142683163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant