Healthcare Provider Details

I. General information

NPI: 1023490786
Provider Name (Legal Business Name): WILFRED GLENN LEVASSEUR ARNP, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 17TH AVE UNIT 101
SEATTLE WA
98122-6772
US

IV. Provider business mailing address

155 17TH AVE UNIT 101
SEATTLE WA
98122-6772
US

V. Phone/Fax

Practice location:
  • Phone: 425-998-8277
  • Fax:
Mailing address:
  • Phone: 206-992-1255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61483024
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60204513
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: