Provider Demographics
NPI:1619477296
Name:LEGBARA, BRIDGET (RN)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:LEGBARA
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 1:1329 MARCHANT PL
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-5424
Mailing Address - Country:US
Mailing Address - Phone:214-228-4853
Mailing Address - Fax:469-630-0183
Practice Address - Street 1:285 W SOUTHWEST PKWY
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-7770
Practice Address - Country:US
Practice Address - Phone:214-228-4853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX781409163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health