Individual
MRS. LEISA DAWN BLANCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1307 S MAIN ST, LOCKWOOD, MO 65682-8327
(417) 232-4560
(417) 232-4611
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
142484
MO
363LF0000X
Family Nurse Practitioner
Primary
2015034072
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861693640
—
MO
05
—
359160504
—
MO
Enumeration date
05/30/2007
Last updated
02/08/2016
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