Provider Demographics
NPI:1407964851
Name:LEGRANDE, CATHERINE C (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:C
Last Name:LEGRANDE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:CATHERINE
Other - Middle Name:M
Other - Last Name:CRUTCHFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3010 TRENWEST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3208
Mailing Address - Country:US
Mailing Address - Phone:336-718-5844
Mailing Address - Fax:336-970-5298
Practice Address - Street 1:3010 TRENWEST DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3208
Practice Address - Country:US
Practice Address - Phone:336-718-5844
Practice Address - Fax:336-970-5298
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00545363A00000X
LAPA.200364363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0598PAMedicaid
LA2127276Medicaid
SC0598PAMedicaid
NC2766656Medicare PIN
LA2127276Medicaid