Provider Demographics
NPI:1649520974
Name:LEVIN, MARY (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:LEVIN
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:LEVIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, IBCLC
Mailing Address - Street 1:9094 E MINERAL CIR STE 120
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-7201
Mailing Address - Country:US
Mailing Address - Phone:303-779-5437
Mailing Address - Fax:303-689-9628
Practice Address - Street 1:9094 E MINERAL CIR STE 120
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-7201
Practice Address - Country:US
Practice Address - Phone:303-779-5437
Practice Address - Fax:303-689-9628
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19613387174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN