Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | NP4260 | CO |
Y | 363LG0600X | Nurse Practitioner - Gerontology | APN.0004260-NP | CO |
NPI | 1063529154 |
---|---|
Provider Name | Nisa Cheryl Levy |
First Address | Aurora, CO 80042-0429 |
Second Address | Aurora, CO 80045-1614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 17/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
90423348 | (05) | CO |
Q09908 | (02) |