Provider Demographics
NPI:1891088134
Name:LEGROS, CAITLIN PHILLIPS (CNM)
Entity Type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:PHILLIPS
Last Name:LEGROS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:S
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 668
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-5705
Mailing Address - Fax:
Practice Address - Street 1:125 LATTIMORE RD STE 200
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4155
Practice Address - Country:US
Practice Address - Phone:585-273-3608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1627367A00000X
NY001627367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife