Provider Demographics
NPI:1639898026
Name:LEVESQUE, ELYSHA JACLYN
Entity Type:Individual
Prefix:
First Name:ELYSHA
Middle Name:JACLYN
Last Name:LEVESQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 N 1ST ST STE 112&124
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-6800
Mailing Address - Country:US
Mailing Address - Phone:559-476-2177
Mailing Address - Fax:833-409-2134
Practice Address - Street 1:3636 N 1ST ST STE 162
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-6869
Practice Address - Country:US
Practice Address - Phone:559-476-2166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker