MEDICARE: MARGARET ANN LEVERETT RNCNP

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	N-14650	ID

General Provider Information

NPI Number	:	1699701615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET ANN LEVERETT RNCNP

Provider Business Mailing Address
First Line	:	PO BOX 2426
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83403-2426
Country	:	US
Telephone Number	:	208-535-9009
Fax Number	:	208-535-9020

Provider Business Practice Location Address
First Line	:	2305 CORONADO STREET
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404
Country	:	US
Telephone Number	:	208-535-9009
Fax Number	:	208-535-9020

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	09/14/2016

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