Provider Demographics
NPI:1952068868
Name:LEVESQUE, MERYL RICHARDSON (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MERYL
Middle Name:RICHARDSON
Last Name:LEVESQUE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:MERYL
Other - Middle Name:ELIZABETH
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:360 US HIGHWAY 1 BYP UNIT 102
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7105
Mailing Address - Country:US
Mailing Address - Phone:603-410-6700
Mailing Address - Fax:603-319-8308
Practice Address - Street 1:1420 MAIN ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-3680
Practice Address - Country:US
Practice Address - Phone:207-850-5744
Practice Address - Fax:207-850-5729
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-26
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP211345363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily