Provider Demographics
NPI:1811373467
Name:LEGARE, AMELIA BRADLEY (RN)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:BRADLEY
Last Name:LEGARE
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 1:49 MONTGOMERY ST
Mailing Address - Street 2:P.O. BOX 240
Mailing Address - City:TIVOLI
Mailing Address - State:NY
Mailing Address - Zip Code:12583-5713
Mailing Address - Country:US
Mailing Address - Phone:845-546-1665
Mailing Address - Fax:
Practice Address - Street 1:6339 MILL ST
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1427
Practice Address - Country:US
Practice Address - Phone:845-871-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY679850163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse