1376689299 NPI number — CYNTHIA O LEBLANC CRNA

Table of content: CYNTHIA O LEBLANC CRNA (NPI 1376689299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376689299 NPI number — CYNTHIA O LEBLANC CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEBLANC
Provider First Name:
CYNTHIA
Provider Middle Name:
O
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
POWELL
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
O
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376689299
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2321 OLYMPIA DR STE 100A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLOWER MOUND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75028-1856
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-350-0225
Provider Business Mailing Address Fax Number:
972-350-0228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 FOUCHER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70115-3515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-779-5515
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN087975 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)