Provider Demographics
NPI:1063969236
Name:LEVIN, DEBRA L
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:LEVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8152 NORTHUMBERLAND HWY
Mailing Address - Street 2:
Mailing Address - City:HEATHSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22473-3309
Mailing Address - Country:US
Mailing Address - Phone:804-580-7200
Mailing Address - Fax:804-580-7063
Practice Address - Street 1:8152 NORTHUMBERLAND HWY
Practice Address - Street 2:
Practice Address - City:HEATHSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22473-3309
Practice Address - Country:US
Practice Address - Phone:804-580-7200
Practice Address - Fax:804-580-7063
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173881363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05380OtherGROUP PTAN