| NPI | 1659631208 |
|---|---|
| Former Name | MICHELLE LISE LEVESQUE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110003843) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MD C0004733) |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2021-11-19 |