MEDICARE: KRISTIN LEBLANC NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	0993928-NP	CO

General Provider Information

NPI Number	:	1861979775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN LEBLANC NP

Provider Business Mailing Address
First Line	:	2363 ADOBE DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2487
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 S COLLEGE AVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1073
Country	:	US
Telephone Number	:	970-568-8799
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2018
Last Update Date	:	07/24/2018

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