Provider Demographics
NPI:1386611333
Name:LUXA-LEBLANC, NANCY (PA)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:LUXA-LEBLANC
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N CLAYTON ST
Mailing Address - Street 2:MEDICAL OFFICE BLDG 401
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-3165
Mailing Address - Country:US
Mailing Address - Phone:302-421-4800
Mailing Address - Fax:302-421-4189
Practice Address - Street 1:701 N CLAYTON ST
Practice Address - Street 2:MEDICAL OFFICE BLDG 401
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3165
Practice Address - Country:US
Practice Address - Phone:302-421-4800
Practice Address - Fax:302-421-4189
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0000596363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q41476-51006THOROtherBLUE SHIELD DE
2120316000OtherKEYSTONE
2120316000OtherBLUE SHIELD PC
DE0001001202Medicaid
2935112OtherAETNA
P90044Medicare UPIN
DE0001001202Medicaid