Provider Demographics
NPI:1699701615
Name:LEVERETT, MARGARET ANN (RNCNP)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ANN
Last Name:LEVERETT
Suffix:
Gender:F
Credentials:RNCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2426
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83403-2426
Mailing Address - Country:US
Mailing Address - Phone:208-535-9009
Mailing Address - Fax:208-535-9020
Practice Address - Street 1:2305 CORONADO STREET
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404
Practice Address - Country:US
Practice Address - Phone:208-535-9009
Practice Address - Fax:208-535-9020
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-14650363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1347213Medicare ID - Type Unspecified