Provider Demographics
NPI:1679755425
Name:LEBLANC, LOUISE A (LNP)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:A
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:LNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5895 TRINITY PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1995
Mailing Address - Country:US
Mailing Address - Phone:703-802-2004
Mailing Address - Fax:
Practice Address - Street 1:5895 TRINITY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-1995
Practice Address - Country:US
Practice Address - Phone:703-802-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164061363LA2200X
VA0017136834363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0017136834OtherAUTH TO PRESCRIBE LICENSE