Provider Demographics
NPI:1841278264
Name:LEVASSEUR, JENNIFER L (CRNA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:LEVASSEUR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3998 FAIR RIGDE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2921
Mailing Address - Country:US
Mailing Address - Phone:703-295-9360
Mailing Address - Fax:703-766-9725
Practice Address - Street 1:789 CENTRAL AVENUE
Practice Address - Street 2:WENTWORTH DOUGLAS HOSPITAL
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820
Practice Address - Country:US
Practice Address - Phone:603-742-5252
Practice Address - Fax:603-749-2453
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH0363472311367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3081812Medicaid
NH30343888Medicaid
NHRE8361Medicare PIN