Healthcare Provider Details

I. General information

NPI: 1629065818
Provider Name (Legal Business Name): TRACY LEE LEVERONE APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 BEDFORD ST
WHITMAN MA
02382-1820
US

IV. Provider business mailing address

288 BEDFORD ST
WHITMAN MA
02382-1820
US

V. Phone/Fax

Practice location:
  • Phone: 781-447-6425
  • Fax: 781-447-1786
Mailing address:
  • Phone: 781-447-6425
  • Fax: 781-447-1786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number169947
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: