Provider Demographics
NPI:1083144042
Name:LEGER, HOLLY MERRILL (RVT)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:MERRILL
Last Name:LEGER
Suffix:
Gender:F
Credentials:RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 CASCADE DR
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-9422
Mailing Address - Country:US
Mailing Address - Phone:985-413-9770
Mailing Address - Fax:
Practice Address - Street 1:320 CASCADE DR
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-9422
Practice Address - Country:US
Practice Address - Phone:985-413-9770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1408852085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA46-1900980OtherSTATE OF LOUISIANA