Provider Demographics
NPI:1386311082
Name:LEVESQUE, DAVID JAMES (CRNA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
Last Name:LEVESQUE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 VICOT WAY
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4919
Mailing Address - Country:US
Mailing Address - Phone:480-452-4792
Mailing Address - Fax:
Practice Address - Street 1:4700 LADY MOON DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-4426
Practice Address - Country:US
Practice Address - Phone:970-821-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0997255367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered