Provider Demographics
NPI:1487486726
Name:LEAVITT, JEREMIAH JONAH
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:JONAH
Last Name:LEAVITT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 DEBARR RD STE 201
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3103
Mailing Address - Country:US
Mailing Address - Phone:907-727-4812
Mailing Address - Fax:907-258-1091
Practice Address - Street 1:1021 E 3RD AVE STE 201
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-6102
Practice Address - Country:US
Practice Address - Phone:907-727-4812
Practice Address - Fax:907-258-1091
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker