Healthcare Provider Details

I. General information

NPI: 1831558097
Provider Name (Legal Business Name): JESSICA HOFFNER LEVENTHAL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CHURCH ST S STE 401
NEW HAVEN CT
06519-1717
US

IV. Provider business mailing address

360 STATE ST
NEW HAVEN CT
06510-3601
US

V. Phone/Fax

Practice location:
  • Phone: 475-331-8966
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number129997
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number700723
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number006955
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: