Healthcare Provider Details

I. General information

NPI: 1639294473
Provider Name (Legal Business Name): ANDRE M LEBLANC CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 PETERMAN DR
ALEXANDRIA LA
71301-3432
US

IV. Provider business mailing address

PO BOX 5887
ALEXANDRIA LA
71307-5887
US

V. Phone/Fax

Practice location:
  • Phone: 318-442-5399
  • Fax: 318-442-1586
Mailing address:
  • Phone: 318-442-5399
  • Fax: 318-442-1586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPO1612
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: