Provider Demographics
NPI:1336526292
Name:LEVERETT, INGA MONAE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:INGA
Middle Name:MONAE
Last Name:LEVERETT
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 E OUTER DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-3446
Mailing Address - Country:US
Mailing Address - Phone:313-366-2000
Mailing Address - Fax:313-369-0143
Practice Address - Street 1:4909 E OUTER DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-3446
Practice Address - Country:US
Practice Address - Phone:313-366-2000
Practice Address - Fax:313-369-3950
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704234972363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily