Basic Information
| Provider Information | |||||||||
| NPI: | 1003293010 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOONEY-LEVIN | ||||||||
| FirstName: | MEREDITH | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 W CORNELIA AVE | ||||||||
| Address2: | APT 104 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606571596 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 736 N 38TH ST UNIT C | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191041655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2673227700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2015 | ||||||||
| LastUpdateDate: | 01/29/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | R213871 | MD | N | Nursing Service Providers | Registered Nurse | 163W00000X | L1-0043499 | DE | N | Nursing Service Providers | Registered Nurse | 163W00000X | RN627638 | PA | N | Nursing Service Providers | Registered Nurse | 163W00000X | 26NR16665000 | NJ | N | Nursing Service Providers | Registered Nurse | 163W00000X | 041429932 | IL | N | Nursing Service Providers | Registered Nurse | 367500000X | 209013035 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | RN627638 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.