Healthcare Provider Details

I. General information

NPI: 1033020516
Provider Name (Legal Business Name): MARLAYNA HEBERT LEBLANC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6505 WOODLAWN RD
MAURICE LA
70555-4202
US

IV. Provider business mailing address

6505 WOODLAWN RD
MAURICE LA
70555-4202
US

V. Phone/Fax

Practice location:
  • Phone: 337-278-7874
  • Fax:
Mailing address:
  • Phone: 337-278-7874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1035
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: