Healthcare Provider Details

I. General information

NPI: 1043640717
Provider Name (Legal Business Name): MRS. DINAH J LEVANEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16909 NE 223RD CIR
BATTLE GROUND WA
98604-4741
US

IV. Provider business mailing address

16909 NE 223RD CIR
BATTLE GROUND WA
98604-4741
US

V. Phone/Fax

Practice location:
  • Phone: 360-687-3723
  • Fax: 360-687-9853
Mailing address:
  • Phone: 360-687-3723
  • Fax: 360-687-9853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: