Provider Demographics
NPI:1417287228
Name:LEGRAND, TONYA
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:LEGRAND
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 1:2875 E RAAB RD
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-9540
Mailing Address - Country:US
Mailing Address - Phone:309-706-8243
Mailing Address - Fax:
Practice Address - Street 1:2875 E RAAB RD
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-9540
Practice Address - Country:US
Practice Address - Phone:309-706-8243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant