Healthcare Provider Details

I. General information

NPI: 1003293010
Provider Name (Legal Business Name): MEREDITH MOONEY-LEVIN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 N 38TH ST UNIT C
PHILADELPHIA PA
19104-1655
US

IV. Provider business mailing address

1111 W CORNELIA AVE APT 104
CHICAGO IL
60657-1596
US

V. Phone/Fax

Practice location:
  • Phone: 267-322-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR213871
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0043499
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN627638
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR16665000
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041429932
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209013035
License Number StateIL
# 7
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN627638
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: