Healthcare Provider Details

I. General information

NPI: 1538308093
Provider Name (Legal Business Name): ANNE MARIE LEBLANC APRN BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2009
Last Update Date: 02/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SPRINGS ROAD BLDG 5, RM 135D VA MEDICAL CENTER
BEDFORD MA
01730
US

IV. Provider business mailing address

1 LASALETTE DR
BURLINGTON MA
01803-2722
US

V. Phone/Fax

Practice location:
  • Phone: 781-687-3191
  • Fax:
Mailing address:
  • Phone: 781-272-4497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number91083
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: