1568762672 NPI number — AMY M LEBLANC PA-C

Table of content: AMY M LEBLANC PA-C (NPI 1568762672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568762672 NPI number — AMY M LEBLANC PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEBLANC
Provider First Name:
AMY
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1568762672
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 PLEASANT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03301-2598
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-227-7000
Provider Business Mailing Address Fax Number:
603-216-3800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 SPRING ST STE 2A1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LACONIA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03246-3113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-524-1600
Provider Business Practice Location Address Fax Number:
603-227-7556
Provider Enumeration Date:
10/25/2010

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: 363A00000X , with the licence number:  0798 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0798 . This is a "LICENSE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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