Provider Demographics
NPI:1922000785
Name:LEBLANC, MICHELE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 NOTT ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2589
Mailing Address - Country:US
Mailing Address - Phone:518-374-3123
Mailing Address - Fax:518-374-9711
Practice Address - Street 1:1201 NOTT ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2589
Practice Address - Country:US
Practice Address - Phone:518-374-3123
Practice Address - Fax:518-374-9711
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY395866-1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
X00000OtherAMERICAN PROGRESSIVE TODA
10002421OtherCDPHP
395866-1OtherTRICARE NORTH REGION
R6B61OtherEMPIRE BLUE CROSS
4123066OtherMVP
9701844OtherGHI
000495041001OtherBLUE SHIELD NENY
BB8379OtherFIDELIS MEDICARE
X00000OtherAMERICAN PROGRESSIVE TODA
9701844OtherGHI