Provider Demographics
NPI:1114534658
Name:LEGO, ANN MICHELLE
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MICHELLE
Last Name:LEGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 ROCK CRUSHER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DANESE
Mailing Address - State:WV
Mailing Address - Zip Code:25831-7187
Mailing Address - Country:US
Mailing Address - Phone:304-640-7585
Mailing Address - Fax:
Practice Address - Street 1:221 ROCK CRUSHER RIDGE RD
Practice Address - Street 2:
Practice Address - City:DANESE
Practice Address - State:WV
Practice Address - Zip Code:25831-7187
Practice Address - Country:US
Practice Address - Phone:304-640-7585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant