Provider Demographics
NPI:1649667536
Name:LEVECK, DONNA
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:LEVECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9072 OTSEGO PIKE
Mailing Address - Street 2:
Mailing Address - City:RUDOLPH
Mailing Address - State:OH
Mailing Address - Zip Code:43462-9748
Mailing Address - Country:US
Mailing Address - Phone:419-601-2390
Mailing Address - Fax:
Practice Address - Street 1:9072 OTSEGO PIKE
Practice Address - Street 2:
Practice Address - City:RUDOLPH
Practice Address - State:OH
Practice Address - Zip Code:43462-9748
Practice Address - Country:US
Practice Address - Phone:419-601-2390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-19
Last Update Date:2015-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3064642374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3064642Medicaid