Provider Demographics
NPI:1063529154
Name:LEVY, NISA CHERYL (NP)
Entity type:Individual
Prefix:
First Name:NISA
Middle Name:CHERYL
Last Name:LEVY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NISA
Other - Middle Name:CHERYL
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:303-493-7000
Mailing Address - Fax:
Practice Address - Street 1:1635 AURORA CT.
Practice Address - Street 2:SENIOR'S CLINIC, ANSCHUTZ OUTPATIENT PAVILLION, 5TH FLO
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-1614
Practice Address - Country:US
Practice Address - Phone:720-848-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONP4260363L00000X
COAPN.0004260-NP363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO90423348Medicaid
Q09908Medicare UPIN
C526048Medicare ID - Type Unspecified