MEDICARE: LESLIE A LEVEILLE NP

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
1	363L00000X	Nurse Practitioner	245527	MA

General Provider Information

NPI Number	:	1518920321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE A LEVEILLE NP

Provider Business Mailing Address
First Line	:	2B WEST STREET
Second Line	:
City	:	WEYMOUTH
State	:	MA
Zip	:	02190
Country	:	US
Telephone Number	:	781-340-4293
Fax Number	:	781-340-3782

Provider Business Practice Location Address
First Line	:	2 WEST ST
Second Line	:
City	:	WEYMOUTH
State	:	MA
Zip	:	02190-1861
Country	:	US
Telephone Number	:	781-340-4293
Fax Number	:	781-340-3782

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	07/08/2007

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