Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 4995 | CO |
NPI | 1417352535 |
---|---|
Provider Name | Dr. Susan Leblanc |
First Address | Evergreen, CO 80439-4939 |
Second Address | Evergreen, CO 80439-4939 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2014 |
Last Update Date | 31/10/2014 |