Provider Demographics
NPI:1750755468
Name:LEVESQUE, DIANE (R N)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:LEVESQUE
Suffix:
Gender:F
Credentials:R N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 COLEMAN
Mailing Address - Street 2:APT 232
Mailing Address - City:MT PLEASANT
Mailing Address - State:SOUTH CAROLINA
Mailing Address - Zip Code:29464
Mailing Address - Country:UM
Mailing Address - Phone:843-530-7545
Mailing Address - Fax:
Practice Address - Street 1:4050 BRIDGEVIEW DRIVE
Practice Address - Street 2:SUITE 600
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405
Practice Address - Country:US
Practice Address - Phone:843-953-0038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21352163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse