Provider Demographics
NPI:1215623954
Name:LEYVA, MANSURA ISRAEL (CRNP)
Entity type:Individual
Prefix:MRS
First Name:MANSURA
Middle Name:ISRAEL
Last Name:LEYVA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11672 DRUMCASTLE TER
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-5635
Mailing Address - Country:US
Mailing Address - Phone:240-565-9975
Mailing Address - Fax:
Practice Address - Street 1:11921 ROCKVILLE PIKE STE 505
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2758
Practice Address - Country:US
Practice Address - Phone:301-881-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-14
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR220689363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily