Healthcare Provider Details

I. General information

NPI: 1770561037
Provider Name (Legal Business Name): KEVIN R LEBLANC N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PAGE ST
NEW BEDFORD MA
02740-3464
US

IV. Provider business mailing address

200 MILL RD SUITE 180
FAIRHAVEN MA
02719-5252
US

V. Phone/Fax

Practice location:
  • Phone: 508-973-5918
  • Fax: 508-973-5916
Mailing address:
  • Phone: 508-973-2000
  • Fax: 508-973-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number236818
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: