Healthcare Provider Details

I. General information

NPI: 1275673873
Provider Name (Legal Business Name): ANDREE ELIZABETH LEBLANC FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 FRONTAGE ROAD A
GRAY LA
70359-6301
US

IV. Provider business mailing address

215 SAINT PETER ST
RACELAND LA
70394-2712
US

V. Phone/Fax

Practice location:
  • Phone: 985-580-1200
  • Fax:
Mailing address:
  • Phone: 985-688-3651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPO1232
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: