Provider Demographics
NPI:1124423090
Name:LEVY, JANENE MICHELLE
Entity type:Individual
Prefix:
First Name:JANENE
Middle Name:MICHELLE
Last Name:LEVY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANENE
Other - Middle Name:MICHELLE
Other - Last Name:LEVY-STILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:1632 HARTSDALE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-3605
Mailing Address - Country:US
Mailing Address - Phone:443-802-7892
Mailing Address - Fax:
Practice Address - Street 1:6801 BELAIR RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-1121
Practice Address - Country:US
Practice Address - Phone:443-372-7890
Practice Address - Fax:855-714-2796
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR144895363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD723008700Medicaid