Provider Demographics
NPI:1245586916
Name:LEBLO, JENNIFER S (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:LEBLO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1210 MEDICAL ARTS BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3461
Practice Address - Country:US
Practice Address - Phone:765-298-5280
Practice Address - Fax:765-298-5279
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004028A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01157053OtherRR MEDICARE PTAN
IN201082550Medicaid
INP01157053OtherRR MEDICARE PTAN