Individual
MRS. LORI LEBLANC GRUNDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1355 SAM HOUSTON JONES PKWY, LAKE CHARLES, LA 70611-5470
(337) 513-0299
Mailing address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.200509
LA
363A00000X
Physician Assistant
PA00230
MS
363AM0700X
Medical Physician Assistant
PA.200509
LA
363AM0700X
Medical Physician Assistant
PA08214
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06082548
—
MS
Enumeration date
01/18/2012
Last updated
10/11/2021
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