MEDICARE: CAROL SUE LEVEQUE AP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AP 914	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP 914	OTHER	FL	LICENSED ACUPUNCTURIST

General Provider Information

NPI Number	:	1891749370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL SUE LEVEQUE AP

Provider Business Mailing Address
First Line	:	12621 NEW BRITTANY BLVD
Second Line	:	BLD 17
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3631
Country	:	US
Telephone Number	:	239-274-6188
Fax Number	:	239-274-6186

Provider Business Practice Location Address
First Line	:	12621 NEW BRITTANY BLVD
Second Line	:	BLD 17
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3631
Country	:	US
Telephone Number	:	239-274-6188
Fax Number	:	239-274-6186

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	07/08/2007

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Directions to “ CAROL SUE LEVEQUE AP” Practice Location

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