Provider Demographics
NPI:1225739477
Name:LEBLANC, ANDREW JUDE (DNP(C), CRNA)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JUDE
Last Name:LEBLANC
Suffix:
Gender:M
Credentials:DNP(C), CRNA
Other - Prefix:
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Mailing Address - Street 1:608 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:DELCAMBRE
Mailing Address - State:LA
Mailing Address - Zip Code:70528-3608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1214 COOLIDGE BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2621
Practice Address - Country:US
Practice Address - Phone:337-289-7991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI253383-30163W00000X
LARN147858163W00000X
LA231769367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse