Provider Demographics
NPI:1336411305
Name:LEVAN, EMILY R (APRN,FNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:R
Last Name:LEVAN
Suffix:
Gender:F
Credentials:APRN,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:ATT: CVMC FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-371-4263
Mailing Address - Fax:802-371-4481
Practice Address - Street 1:73 MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-2932
Practice Address - Country:US
Practice Address - Phone:802-225-8355
Practice Address - Fax:802-223-8105
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0085969363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1020575Medicaid
VTY400151697OtherMEDICARE PTAN LINKED TO CVMC-