Provider Demographics
NPI:1376765321
Name:LEGENDRE, DIANE MARIE (RN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:LEGENDRE
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 1:37 KING JAMES RD
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03748-3817
Mailing Address - Country:US
Mailing Address - Phone:603-206-4335
Mailing Address - Fax:
Practice Address - Street 1:37 KING JAMES RD
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:NH
Practice Address - Zip Code:03748-3817
Practice Address - Country:US
Practice Address - Phone:603-206-4335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH047387-21163WA0400X, 171M00000X
VT026-0035334172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker