Provider Demographics
NPI:1053946814
Name:LEGGETT, MARY (RN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:LEGGETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 NORTHBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-1533
Mailing Address - Country:US
Mailing Address - Phone:860-752-9348
Mailing Address - Fax:
Practice Address - Street 1:1 NORTHBROOK DR
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-1533
Practice Address - Country:US
Practice Address - Phone:860-752-9348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT082855163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse