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NPI Code Detail

MEDICARE: MRS. SAMANTHA A LEVERTON APN

MEDICARE: MRS. SAMANTHA A LEVERTON APN
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
1363LF0000XFamily Nurse Practitioner209-013048IL

General Provider Information

NPI Number : 1891161030
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SAMANTHA A LEVERTON APN
Provider Business Mailing Address
First Line : 530 NE GLEN OAK AVE
Second Line :
City : PEORIA
State : IL
Zip : 61637-0001
Country : US
Telephone Number : 309-624-8818
Fax Number : 309-624-8820
Provider Business Practice Location Address
First Line : 530 NE GLEN OAK AVE
Second Line :
City : PEORIA
State : IL
Zip : 61637-0001
Country : US
Telephone Number : 309-624-8818
Fax Number : 309-624-8820
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2015
Last Update Date : 05/20/2026

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