Provider Demographics
NPI:1396016762
Name:LEBLANC, MICHELE DENISE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:DENISE
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 EDGARTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:VINEYARD HAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02568
Mailing Address - Country:US
Mailing Address - Phone:508-693-7900
Mailing Address - Fax:508-696-0401
Practice Address - Street 1:111 EDGARTOWN ROAD
Practice Address - Street 2:
Practice Address - City:OAK BLUFFS
Practice Address - State:MA
Practice Address - Zip Code:02557
Practice Address - Country:US
Practice Address - Phone:508-693-7900
Practice Address - Fax:508-696-0401
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA99629163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health