Provider Demographics
NPI:1013262898
Name:MCLEGGAN, JENNIFER C (RN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:MCLEGGAN
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 1:18705 HILBURN AVE
Mailing Address - Street 2:SAINT ALBANS
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-1931
Mailing Address - Country:US
Mailing Address - Phone:347-869-7643
Mailing Address - Fax:
Practice Address - Street 1:18705 HILBURN AVE
Practice Address - Street 2:SAINT ALBANS
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-1931
Practice Address - Country:US
Practice Address - Phone:347-869-7643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY655863-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse