MEDICARE: JENNA LEVY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	0506176	NV

General Provider Information

NPI Number	:	1154720241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA LEVY

Provider Business Mailing Address
First Line	:	7253 BINDWEED RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-3213
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7253 BINDWEED RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-3213
Country	:	US
Telephone Number	:	702-217-7861
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2014
Last Update Date	:	08/14/2014

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Directions to “ JENNA LEVY ” Practice Location

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