Healthcare Provider Details

I. General information

NPI: 1225739477
Provider Name (Legal Business Name): ANDREW JUDE LEBLANC DNP(C), CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 12/22/2024
Certification Date: 12/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GREENLEAVES BLVD
MANDEVILLE LA
70448-7018
US

IV. Provider business mailing address

608 W CHURCH ST
DELCAMBRE LA
70528-3608
US

V. Phone/Fax

Practice location:
  • Phone: 855-300-7525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number253383-30
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN147858
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number231769
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: