Provider Demographics
NPI:1043938459
Name:LEQUE, ADRIAN A (MS, RDN, CSG, LD)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:A
Last Name:LEQUE
Suffix:
Gender:F
Credentials:MS, RDN, CSG, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W2403 FOX COULEE RD
Mailing Address - Street 2:
Mailing Address - City:NELSON
Mailing Address - State:WI
Mailing Address - Zip Code:54756-8000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24 8TH ST NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-6817
Practice Address - Country:US
Practice Address - Phone:507-424-4028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3251133VN1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1101XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Gerontological