Healthcare Provider Details

I. General information

NPI: 1902189798
Provider Name (Legal Business Name): NICOLE LEBLANC DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SW 30TH STREET COLLEGE OF VETERINARY MEDICINE OREGON STATE UNIVERSITY
CORVALLIS OR
97331
US

IV. Provider business mailing address

700 SW 30TH STREET COLLEGE OF VETERINARY MEDICINE OREGON STATE UNIVERSITY
CORVALLIS OR
97331
US

V. Phone/Fax

Practice location:
  • Phone: 541-737-2098
  • Fax:
Mailing address:
  • Phone: 541-737-2098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number6464-050
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: