Provider Demographics
NPI:1912963356
Name:LEBLANC, DONNA B (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:B
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 W MARKHAM ST # 514
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-526-4020
Mailing Address - Fax:501-526-4029
Practice Address - Street 1:5800 W 10TH ST STE 605
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-1773
Practice Address - Country:US
Practice Address - Phone:501-526-4020
Practice Address - Fax:501-526-4029
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAO2939363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425802204Medicaid
MO819621112Medicare ID - Type Unspecified
P53962Medicare UPIN