Healthcare Provider Details

I. General information

NPI: 1568942019
Provider Name (Legal Business Name): RACHEL LYNNE LEVISEUR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PEACH ST STE 200
ERIE PA
16507-1423
US

IV. Provider business mailing address

100 PEACH ST STE 200
ERIE PA
16507-1423
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-7733
  • Fax: 814-456-7213
Mailing address:
  • Phone: 814-877-7733
  • Fax: 814-456-7213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA004585
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA060039
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: