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General NPI Number Information
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NPI Number | 1033645726
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Entity Type | Individual
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Provider Name | CRYSTAL DAWN LEBOEUF PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/02/2017
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 1097 MAIN ST
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City | SAINT JOHNSBURY
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State | VT
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Zip | 05819-2646
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Country | US
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Telephone | 802-255-8788
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Fax | 802-200-0493
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Provider Business Mailing Address
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Address Line | PO BOX 65
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City | SAINT JOHNSBURY
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State | VT
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Zip | 05819-0065
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Country | US
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Telephone | 802-255-8788
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Fax | 802-200-0493
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 101.0135005
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 026.0122541
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License Number State | VT
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 073848-21
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License Number State | NH
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