Provider Demographics
NPI:1558009795
Name:LEGUILLOU, NINOSHKA MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:NINOSHKA
Middle Name:MARIE
Last Name:LEGUILLOU
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 BERTHA ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12209-2103
Mailing Address - Country:US
Mailing Address - Phone:718-864-9368
Mailing Address - Fax:
Practice Address - Street 1:44 BERTHA ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12209-2103
Practice Address - Country:US
Practice Address - Phone:718-864-9368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335229164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse