Provider Demographics
NPI:1326486721
Name:LEBLANC, JESSICA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:ETIENNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1351 E 87TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5135
Mailing Address - Country:US
Mailing Address - Phone:347-372-3746
Mailing Address - Fax:
Practice Address - Street 1:1351 E 87TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5135
Practice Address - Country:US
Practice Address - Phone:347-372-3746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314230164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse