Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN627576 | PA |
N | 363LP0200X | Nurse Practitioner - Pediatrics | RN627576 | PA |
NPI | 1003302399 |
---|---|
Provider Name | Jaime Levine |
First Address | Elkins Park, PA 19027-1046 |
Second Address | Elkins Park, PA 19027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2018 |
Last Update Date | 21/08/2018 |