Healthcare Provider Details

I. General information

NPI: 1639695349
Provider Name (Legal Business Name): ALYSSA REBECCA LEVINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date: 03/26/2020
Reactivation Date: 04/08/2020

III. Provider practice location address

1155 MILL ST
RENO NV
89502-1576
US

IV. Provider business mailing address

1155 MILL ST
RENO NV
89502-1576
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number2080P0203X
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: