Healthcare Provider Details

I. General information

NPI: 1386259299
Provider Name (Legal Business Name): MARY LEFEVRE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 09/09/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 ADAM CLAYTON POWELL JR BLVD
NEW YORK NY
10027-4990
US

IV. Provider business mailing address

2090 ADAM CLAYTON POWELL JR BLVD
NEW YORK NY
10027-4990
US

V. Phone/Fax

Practice location:
  • Phone: 212-553-6708
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number768763
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: