Provider Demographics
NPI:1154930915
Name:LEBLANC, RICHARD JUDE (RN,MN)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:JUDE
Last Name:LEBLANC
Suffix:
Gender:M
Credentials:RN,MN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 KALISTE SALOOM RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5705
Mailing Address - Country:US
Mailing Address - Phone:337-470-1000
Mailing Address - Fax:337-470-1006
Practice Address - Street 1:1105 KALISTE SALOOM RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5705
Practice Address - Country:US
Practice Address - Phone:337-470-1000
Practice Address - Fax:337-470-1006
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA045454163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)