Provider Demographics
NPI:1790591386
Name:LEVINE, MICHELLE ANN AMIS (FNP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE ANN
Middle Name:AMIS
Last Name:LEVINE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 DODSON CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-7904
Mailing Address - Country:US
Mailing Address - Phone:732-771-1900
Mailing Address - Fax:
Practice Address - Street 1:818 DODSON CHAPEL RD
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506-7904
Practice Address - Country:US
Practice Address - Phone:732-771-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37777363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner