Provider Demographics
NPI:1902122021
Name:LEVETOWN, NICOLE MELIA (ANP)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:MELIA
Last Name:LEVETOWN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:MELIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 OSBORNE ST
Mailing Address - Street 2:SUITE 131
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6000
Mailing Address - Country:US
Mailing Address - Phone:203-739-7155
Mailing Address - Fax:203-739-8050
Practice Address - Street 1:111 OSBORNE ST
Practice Address - Street 2:SUITE 131
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6000
Practice Address - Country:US
Practice Address - Phone:203-739-7155
Practice Address - Fax:203-739-8050
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY536002163W00000X
NY305273363LA2200X
CT092394163W00000X
CT004338363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400026346Medicare PIN