Provider Demographics
NPI:1477520625
Name:LEBLANC, JOHN (CRNA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:LEBLANC
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 53815
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-3815
Mailing Address - Country:US
Mailing Address - Phone:504-779-5558
Mailing Address - Fax:
Practice Address - Street 1:4500 CLEARVIEW PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2371
Practice Address - Country:US
Practice Address - Phone:504-779-5558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN043166163WP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0000XNursing Service ProvidersRegistered NursePain Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA59798CH22Medicare PIN
LA59798Medicare PIN
LAP00063157Medicare PIN