Healthcare Provider Details

I. General information

NPI: 1356803183
Provider Name (Legal Business Name): LAURA LOUISE LEBLANC FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201A HILL RD
SMITHVILLE TX
78957-9533
US

IV. Provider business mailing address

1201A HILL RD
SMITHVILLE TX
78957-9533
US

V. Phone/Fax

Practice location:
  • Phone: 512-360-5272
  • Fax: 512-360-5273
Mailing address:
  • Phone: 512-360-5272
  • Fax: 512-360-5273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP140661
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: