Provider Demographics
NPI:1992058655
Name:LEVIN, JESSICA MASON (CNM, RN, LAC, LMT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MASON
Last Name:LEVIN
Suffix:
Gender:F
Credentials:CNM, RN, LAC, LMT
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC, LMT
Mailing Address - Street 1:1782 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-4115
Mailing Address - Country:US
Mailing Address - Phone:503-867-1753
Mailing Address - Fax:503-867-1753
Practice Address - Street 1:250 BON AIR RD
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1702
Practice Address - Country:US
Practice Address - Phone:503-867-1753
Practice Address - Fax:503-867-1753
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN95171339163W00000X
ORAC159731171100000X
OR10676225700000X
374J00000X
CANMW235995367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374J00000XNursing Service Related ProvidersDoula