Provider Demographics
NPI:1215494398
Name:LEBLANC, LISA MARIE (APNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 N 117TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-4129
Mailing Address - Country:US
Mailing Address - Phone:414-778-0070
Mailing Address - Fax:
Practice Address - Street 1:3040 N 117TH ST STE 200
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-4129
Practice Address - Country:US
Practice Address - Phone:414-778-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9091-33363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health