Healthcare Provider Details

I. General information

NPI: 1699712182
Provider Name (Legal Business Name): DIANNE R. LEVISOHN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19917 7TH AVE NE STE 203
POULSBO WA
98370-6555
US

IV. Provider business mailing address

19917 7TH AVE NE STE 203
POULSBO WA
98370-6555
US

V. Phone/Fax

Practice location:
  • Phone: 360-824-5474
  • Fax: 360-326-2451
Mailing address:
  • Phone: 360-824-5474
  • Fax: 360-326-2451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD00030159
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: