Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 1209 | MA |
NPI | 1699010421 |
---|---|
Provider Name | Ms. Wendy Ann Leblanc |
First Address | Fitchburg, MA 01420 |
Second Address | Leominster, MA 01453 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2012 |
Last Update Date | 05/12/2012 |