Provider Demographics
NPI:1891349338
Name:LEGRAND, JENNIFER (RDN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LEGRAND
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 RAINTREE IS APT 10
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150
Mailing Address - Country:US
Mailing Address - Phone:863-899-3287
Mailing Address - Fax:
Practice Address - Street 1:62 RAINTREE IS APT 10
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150
Practice Address - Country:US
Practice Address - Phone:863-899-3287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered