Provider Demographics
NPI:1891749370
Name:LEVEQUE, CAROL SUE (AP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:SUE
Last Name:LEVEQUE
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12621 NEW BRITTANY BLVD
Mailing Address - Street 2:BLD 17
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3631
Mailing Address - Country:US
Mailing Address - Phone:239-274-6188
Mailing Address - Fax:239-274-6186
Practice Address - Street 1:12621 NEW BRITTANY BLVD
Practice Address - Street 2:BLD 17
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3631
Practice Address - Country:US
Practice Address - Phone:239-274-6188
Practice Address - Fax:239-274-6186
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 914171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAP 914OtherLICENSED ACUPUNCTURIST