Healthcare Provider Details

I. General information

NPI: 1679635882
Provider Name (Legal Business Name): MARY H LEVENSTEIN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 NORTH RD SUITE 202
BEDFORD MA
01730-1037
US

IV. Provider business mailing address

41 NORTH RD SUITE 202
BEDFORD MA
01730-1037
US

V. Phone/Fax

Practice location:
  • Phone: 781-275-2080
  • Fax: 781-275-5543
Mailing address:
  • Phone: 781-275-2080
  • Fax: 781-275-5543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number158142
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: