Provider Demographics
NPI:1730178492
Name:LEBLANC, JO ANNA DOMIANO (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:JO ANNA
Middle Name:DOMIANO
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:LA
Mailing Address - Zip Code:70342-2084
Mailing Address - Country:US
Mailing Address - Phone:985-385-4357
Mailing Address - Fax:
Practice Address - Street 1:1200 DAVID DR
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1362
Practice Address - Country:US
Practice Address - Phone:985-380-2441
Practice Address - Fax:985-380-2489
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN045561 AP02308363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health