Individual
HOLLY LYNN GOMEZ-LEVINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, CNP
Contact information
Practice address
3500 TOWER AVE, SUPERIOR, WI 54880-4491
(715) 817-7100
(406) 457-8992
Mailing address
1702 UNIVERSITY DR S, FARGO, ND 58103-4940
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
100926
MT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
7182-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000371733
BLUE CROSS-SHIELD OF MONTANA
MT
01
—
P01206032 C01340
RAILROAD MEDICARE FOR C4MH
MT
Enumeration date
07/07/2008
Last updated
05/22/2019
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