MEDICARE: HOLLY LEVIE RN

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	163W00000X	Registered Nurse	0260031866	VT

General Provider Information

NPI Number	:	1881876688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY LEVIE RN

Provider Business Mailing Address
First Line	:	149 S BAILEY HAZEN RD
Second Line	:
City	:	RYEGATE
State	:	VT
Zip	:	05042-0000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	149 SOUTH BAILEY HAZEN RD
Second Line	:
City	:	RYEGATE
State	:	VT
Zip	:	05042-0000
Country	:	US
Telephone Number	:	802-584-4679
Fax Number	:

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

Provider Enumeration Date	:	12/04/2007
Last Update Date	:	12/04/2007

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Directions to “ HOLLY LEVIE RN” Practice Location

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