Provider Demographics
NPI:1427425180
Name:LEBLANC, STEPHANIE PALMER (PA-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:PALMER
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:BEEBE
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 MANHATTAN PL APT 105
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-4032
Mailing Address - Country:US
Mailing Address - Phone:303-507-8490
Mailing Address - Fax:
Practice Address - Street 1:3555 LUTHERAN PKWY STE 200
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6027
Practice Address - Country:US
Practice Address - Phone:720-284-3700
Practice Address - Fax:303-467-0525
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004377363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant