Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | AUD003739 | GA |
NPI | 1356450209 |
---|---|
Provider Name | Mrs. Bari F Levens |
First Address | Evans, GA 30809-3000 |
Second Address | Augusta, GA 30901-2776 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 27/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
373758 | WELLCARE (01) | GA |
7060018218 | (05) | GA |