Basic Information
Provider Information
NPI: 1003293010
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MOONEY-LEVIN
FirstName: MEREDITH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1111 W CORNELIA AVE
Address2: APT 104
City: CHICAGO
State: IL
PostalCode: 606571596
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 736 N 38TH ST UNIT C
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191041655
CountryCode: US
TelephoneNumber: 2673227700
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/28/2015
LastUpdateDate: 01/29/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X041429932ILN Nursing Service ProvidersRegistered Nurse 
163W00000X26NR16665000NJN Nursing Service ProvidersRegistered Nurse 
163W00000XRN627638PAN Nursing Service ProvidersRegistered Nurse 
163W00000XL1-0043499DEN Nursing Service ProvidersRegistered Nurse 
163W00000XR213871MDN Nursing Service ProvidersRegistered Nurse 
367500000XRN627638PAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 
367500000X209013035ILN Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


Home