Provider Demographics
NPI:1396386512
Name:LECLAIRE, ALINA J (FNP)
Entity Type:Individual
Prefix:MS
First Name:ALINA
Middle Name:J
Last Name:LECLAIRE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 BOSTON RD APT M125
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-1151
Mailing Address - Country:US
Mailing Address - Phone:413-695-4321
Mailing Address - Fax:
Practice Address - Street 1:50 MAPLE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1979
Practice Address - Country:US
Practice Address - Phone:413-748-6884
Practice Address - Fax:413-748-6486
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN235234363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily