Provider Demographics
NPI:1033734439
Name:LEVASSEUR, JUDE LEGROS (NP)
Entity Type:Individual
Prefix:
First Name:JUDE
Middle Name:LEGROS
Last Name:LEVASSEUR
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19200 VON KARMAN AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-8513
Mailing Address - Country:US
Mailing Address - Phone:877-628-3367
Mailing Address - Fax:
Practice Address - Street 1:19200 VON KARMAN AVE STE 500
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-8513
Practice Address - Country:US
Practice Address - Phone:949-382-4776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95014463363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health