Provider Demographics
NPI:1114576717
Name:LEGROS, SABIENNE EMILIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SABIENNE
Middle Name:EMILIE
Last Name:LEGROS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HIGHLAND CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-1786
Mailing Address - Country:US
Mailing Address - Phone:412-313-7026
Mailing Address - Fax:
Practice Address - Street 1:2639 MAIN ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2023
Practice Address - Country:US
Practice Address - Phone:860-659-1329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8657363LF0000X, 363LF0000X
NY344224363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA