Provider Demographics
NPI:1104801919
Name:LEVICH, BRIDGET R (MS, RN)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:R
Last Name:LEVICH
Suffix:
Gender:F
Credentials:MS, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4860 Y ST
Mailing Address - Street 2:ACC 2300
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-734-4871
Mailing Address - Fax:916-734-5641
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:ACC 1600
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-3630
Practice Address - Fax:916-734-5550
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CACNS1953163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ21568Medicare UPIN
CAZZZ29968ZMedicare PIN