Provider Demographics
NPI:1134948995
Name:LEGGETT, CAROLYN ANNE (RN)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANNE
Last Name:LEGGETT
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 1:981 SAGRADA CIR N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-3784
Mailing Address - Country:US
Mailing Address - Phone:503-931-7353
Mailing Address - Fax:
Practice Address - Street 1:981 SAGRADA CIR N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-3784
Practice Address - Country:US
Practice Address - Phone:503-931-7353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10033791163WH0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health