Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 26NJ00083700 | NJ |
NPI | 1013935790 |
---|---|
Provider Name | Jennifer Levine |
First Address | Neptune, NJ 07753 |
Second Address | Neptune, NJ 07753 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 23/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0080292 | (05) | NJ |
095869B25 | MEDICARE (01) | NJ |