1992987424 NPI number — MISS NICOLE LEBLANC PT

Table of content: MISS NICOLE LEBLANC PT (NPI 1992987424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992987424 NPI number — MISS NICOLE LEBLANC PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEBLANC
Provider First Name:
NICOLE
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992987424
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 500409
Provider Second Line Business Mailing Address:
1 LOWER NAVY HILL ROAD COMMONWEATH HEALTH CENTER PHYSIC
Provider Business Mailing Address City Name:
SAIPAN
Provider Business Mailing Address State Name:
MP
Provider Business Mailing Address Postal Code:
96950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
670-236-8327
Provider Business Mailing Address Fax Number:
670-234-8930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 LOWER NAVY HILL ROAD
Provider Second Line Business Practice Location Address:
COMMONWEATH HEALTH CENTER PHYSICAL THERAPY DEPT
Provider Business Practice Location Address City Name:
SAIPAN
Provider Business Practice Location Address State Name:
MP
Provider Business Practice Location Address Postal Code:
96950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
670-236-8327
Provider Business Practice Location Address Fax Number:
670-234-8930
Provider Enumeration Date:
11/27/2007

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: 225100000X , with the licence number:  22 , registered in the state of MP ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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