MEDICARE: MRS. LORI LEVIT 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	363LF0000X	Family Nurse Practitioner	4704256982	MI

General Provider Information

NPI Number	:	1811170640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORI LEVIT NP

Provider Business Mailing Address
First Line	:	PO BOX 2644
Second Line	:
City	:	DOUGLAS
State	:	MI
Zip	:	49406-2644
Country	:	US
Telephone Number	:	269-857-1012
Fax Number	:

Provider Business Practice Location Address
First Line	:	30781 STEPHENSON HWY
Second Line	:
City	:	MADISON HTS
State	:	MI
Zip	:	48071-1618
Country	:	US
Telephone Number	:	269-857-1012
Fax Number	:

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

Provider Enumeration Date	:	12/15/2007
Last Update Date	:	12/15/2007

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