Provider Demographics
NPI:1801382528
Name:LEGRAND, JUSTINE ELENA (CPM, LM)
Entity Type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:ELENA
Last Name:LEGRAND
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8413 SPRINGHILL CT
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-6134
Mailing Address - Country:US
Mailing Address - Phone:817-994-7135
Mailing Address - Fax:817-768-6940
Practice Address - Street 1:10345 ALTA VISTA RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6501
Practice Address - Country:US
Practice Address - Phone:817-562-2828
Practice Address - Fax:817-768-6940
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99342176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife