Healthcare Provider Details

I. General information

NPI: 1548726003
Provider Name (Legal Business Name): JAMES BRIAN LEVENSON NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 DIVIDEND DR
LOGANSPORT IN
46947-1572
US

IV. Provider business mailing address

8003 CASTLEWAY DR
INDIANAPOLIS IN
46250-1946
US

V. Phone/Fax

Practice location:
  • Phone: 574-722-7407
  • Fax: 574-847-7203
Mailing address:
  • Phone: 317-576-1335
  • Fax: 317-343-6562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71009372A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: