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General NPI Number Information
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NPI Number | 1053271874
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Entity Type | Individual
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Provider Name | MR. LEVI HAKANSON
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Gender | Male
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Dates
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Enumeration Date | 11/13/2025
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 4847 W TALAMORE DR
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City | MERIDIAN
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State | ID
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Zip | 83646-8846
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Country | US
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Telephone | 208-509-9868
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Fax |
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Provider Business Mailing Address
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Address Line | 2056 KELLY DR
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City | PAYETTE
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State | ID
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Zip | 83661-5013
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Country | US
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Telephone | 208-509-9868
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State | ID
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