Healthcare Provider Details

I. General information

NPI: 1821587320
Provider Name (Legal Business Name): LEEANNE HEBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 AIRPORT RD
FITCHBURG MA
01420-8142
US

IV. Provider business mailing address

2 ABBOT MILL LN APT 9-5
WESTFORD MA
01886-1658
US

V. Phone/Fax

Practice location:
  • Phone: 978-501-4319
  • Fax:
Mailing address:
  • Phone: 978-501-4319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLN102557
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number13600
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: