Healthcare Provider Details

I. General information

NPI: 1639898026
Provider Name (Legal Business Name): ELYSHA JACLYN LEVESQUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 N 1ST ST STE 162
FRESNO CA
93726-6869
US

IV. Provider business mailing address

3636 N 1ST ST STE 112&124
FRESNO CA
93726-6800
US

V. Phone/Fax

Practice location:
  • Phone: 559-476-2166
  • Fax:
Mailing address:
  • Phone: 559-476-2177
  • Fax: 833-409-2134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: