Individual
WANDA LEVERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1525 STATION CENTER BLVD APT 134, SUWANEE, GA 30024
(585) 230-4210
Mailing address
1525 STATION CENTER BLVD APT 134, SUWANEE, GA 30024-8464
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN069862
GA
251E00000X
Home Health Agency
LPN069862
GA
251J00000X
Nursing Care Agency
LPN069862
GA
Other
Enumeration date
12/08/2006
Last updated
05/22/2018
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