Healthcare Provider Details

I. General information

NPI: 1760477012
Provider Name (Legal Business Name): KIM ALISON LEVINSON CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIM GREENFIELD

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 CEDAR STREET
NEW HAVEN CT
06510
US

IV. Provider business mailing address

33 CEDAR STREET PO BOX 208064
NEW HAVEN CT
06510
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-5708
  • Fax:
Mailing address:
  • Phone: 203-785-5708
  • Fax: 203-737-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF3806671
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number6992
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: