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NPI Code Detail

MEDICARE: ANGELA NOEL LEIVIAN B.A.

MEDICARE: ANGELA NOEL LEIVIAN B.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1396015160
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA NOEL LEIVIAN B.A.
Provider Business Mailing Address
First Line : 2120 E HIGHWAY 66
Second Line :
City : EL RENO
State : OK
Zip : 73036-6623
Country : US
Telephone Number : 316-250-0080
Fax Number :
Provider Business Practice Location Address
First Line : 2120 E HIGHWAY 66
Second Line :
City : EL RENO
State : OK
Zip : 73036-6623
Country : US
Telephone Number : 316-250-0080
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2012
Last Update Date : 01/10/2012

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