Provider Demographics
NPI:1588304463
Name:LEBLANC, COURTNEY ASHTON (CNM)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ASHTON
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LISI LN
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-1285
Mailing Address - Country:US
Mailing Address - Phone:774-200-5522
Mailing Address - Fax:
Practice Address - Street 1:3 SHAWS CV
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4952
Practice Address - Country:US
Practice Address - Phone:860-443-4148
Practice Address - Fax:860-574-9040
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT16.000574176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife