Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | CNP201425 | ME |
N | 363LP2300X | Nurse Practitioner - Primary Care | 341032 | NY |
NPI | 1033666110 |
---|---|
Provider Name | Meredith Legg |
First Address | York, ME 03909-1011 |
Second Address | York, ME 03909-1158 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2016 |
Last Update Date | 01/10/2021 |