Provider Demographics
NPI:1215153382
Name:LEBLANC, RAEANN
Entity type:Individual
Prefix:
First Name:RAEANN
Middle Name:
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1467 MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ATHOL
Mailing Address - State:MA
Mailing Address - Zip Code:01331-2652
Mailing Address - Country:US
Mailing Address - Phone:978-249-9736
Mailing Address - Fax:978-249-3922
Practice Address - Street 1:1467 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ATHOL
Practice Address - State:MA
Practice Address - Zip Code:01331-2652
Practice Address - Country:US
Practice Address - Phone:978-249-9736
Practice Address - Fax:978-249-3922
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214661363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care