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General NPI Number Information
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NPI Number | 1508863325
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Entity Type | Individual
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Provider Name | ELIZABETH LEBLANC CRNA
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Gender | Female
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 04/23/2012
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Provider Practice Location Address
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Address Line | 5530 WISCONSIN AVE STE 1550
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City | CHEVY CHASE
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State | MD
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Zip | 20815-4404
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Country | US
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Telephone | 301-220-1333
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Fax | 301-220-1533
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Provider Business Mailing Address
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Address Line | 9117 JEFFERY RD
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City | GREAT FALLS
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State | VA
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Zip | 22066-4120
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Country | US
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Telephone | 703-966-5704
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Fax |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | R150538
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | AC000200
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License Number State | MD
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