Provider Demographics
NPI:1780875856
Name:LEBLANC, JULIE H (CRNA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:H
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:HEITZMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 452015
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33345-2015
Mailing Address - Country:US
Mailing Address - Phone:800-437-2672
Mailing Address - Fax:
Practice Address - Street 1:1214 COOLIDGE BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2621
Practice Address - Country:US
Practice Address - Phone:337-289-7991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA108033367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered