Provider Demographics
NPI:1912058512
Name:LEVENSON, DARCIE L (PA)
Entity Type:Individual
Prefix:
First Name:DARCIE
Middle Name:L
Last Name:LEVENSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-288-2255
Mailing Address - Fax:208-288-1535
Practice Address - Street 1:520 S EAGLE RD
Practice Address - Street 2:SUITE 1241
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6351
Practice Address - Country:US
Practice Address - Phone:208-288-2255
Practice Address - Fax:208-288-1535
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDPA-655363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical