Provider Demographics
NPI:1730740408
Name:LEVENTRY, OLIVIA ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ANNE
Last Name:LEVENTRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-3004
Mailing Address - Country:US
Mailing Address - Phone:814-248-9266
Mailing Address - Fax:
Practice Address - Street 1:109 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-3004
Practice Address - Country:US
Practice Address - Phone:814-248-9266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant