Healthcare Provider Details

I. General information

NPI: 1992429823
Provider Name (Legal Business Name): INDIE LYNN LECLAIR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 OLD ETNA RD
LEBANON NH
03766-1970
US

IV. Provider business mailing address

PO BOX 83
ETNA NH
03750-0083
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-4000
  • Fax: 603-640-1228
Mailing address:
  • Phone: 802-356-3986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number069838-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: