Healthcare Provider Details

I. General information

NPI: 1679534507
Provider Name (Legal Business Name): BARBARA L LEVER GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 UNIVERSITY AVE W
SAINT PAUL MN
55104-3727
US

IV. Provider business mailing address

3030 AQUILA AVE S
SAINT LOUIS PARK MN
55426-2956
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-2002
  • Fax: 651-326-9635
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR141715-5
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: