Healthcare Provider Details

I. General information

NPI: 1417349754
Provider Name (Legal Business Name): KATE LEE LEBLANC APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 HAZARD AVE
ENFIELD CT
06082-4592
US

IV. Provider business mailing address

26 CHAMBERLAIN HWY
KENSINGTON CT
06037-1921
US

V. Phone/Fax

Practice location:
  • Phone: 860-253-5020
  • Fax: 860-253-5030
Mailing address:
  • Phone: 860-731-5522
  • Fax: 860-731-5536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number094197
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number006034
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number006034
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: