Provider Demographics
NPI:1720370562
Name:LEVEILLE, CAM-SUZE (LPN)
Entity Type:Individual
Prefix:MS
First Name:CAM-SUZE
Middle Name:
Last Name:LEVEILLE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3613 AVENUE P
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3423
Mailing Address - Country:US
Mailing Address - Phone:718-290-5729
Mailing Address - Fax:
Practice Address - Street 1:3613 AVENUE P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3423
Practice Address - Country:US
Practice Address - Phone:718-290-5729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193054164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse