Provider Demographics
NPI:1124988621
Name:LEGER MARRERO, GLENNYS D (RN)
Entity type:Individual
Prefix:
First Name:GLENNYS
Middle Name:D
Last Name:LEGER MARRERO
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 1:47 BALLOU AVE
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-4107
Mailing Address - Country:US
Mailing Address - Phone:682-521-5522
Mailing Address - Fax:
Practice Address - Street 1:47 BALLOU AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-4107
Practice Address - Country:US
Practice Address - Phone:682-521-5522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-17
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2347921163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health