Healthcare Provider Details

I. General information

NPI: 1710077441
Provider Name (Legal Business Name): SHIRLEY LEVERTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR STREET HARTFORD HOSPITAL SURGERY DEPT
HARTFORD CT
06102
US

IV. Provider business mailing address

HARTFORD HOSPITAL PROFESSIONAL SERVICES PO BOX 40,000 DEPT 634
HARTFORD CT
06151-0634
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-2840
  • Fax:
Mailing address:
  • Phone: 860-545-7602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License Number002365
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: