Provider Demographics
NPI:1508897844
Name:LEVESQUE, JACQUELINE (FAMILY NURSE PRACTIT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:LEVESQUE
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACTIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 GLEN MARY RD
Mailing Address - Street 2:
Mailing Address - City:BAR HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04609
Mailing Address - Country:US
Mailing Address - Phone:207-288-2848
Mailing Address - Fax:
Practice Address - Street 1:US EMBASSY
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:EO
Practice Address - Zip Code:09806
Practice Address - Country:AF
Practice Address - Phone:07-020-1909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER024409363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily