Provider Demographics
NPI:1760947410
Name:LEGER, ANDREA K (NP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:K
Last Name:LEGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BIRNIE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1375
Mailing Address - Country:US
Mailing Address - Phone:413-734-4206
Mailing Address - Fax:413-301-5613
Practice Address - Street 1:300 BIRNIE AVE STE 102
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1375
Practice Address - Country:US
Practice Address - Phone:413-734-4206
Practice Address - Fax:413-301-5613
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2287040363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner