Provider Demographics
NPI:1396910006
Name:LEGERE, NICOLE RAE (FNP)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:RAE
Last Name:LEGERE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:RAE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC, NP-C
Mailing Address - Street 1:17 N MILES AVE
Mailing Address - Street 2:
Mailing Address - City:HARDIN
Mailing Address - State:MT
Mailing Address - Zip Code:59034-2323
Mailing Address - Country:US
Mailing Address - Phone:406-665-2310
Mailing Address - Fax:
Practice Address - Street 1:17 N MILES AVE
Practice Address - Street 2:
Practice Address - City:HARDIN
Practice Address - State:MT
Practice Address - Zip Code:59034-2323
Practice Address - Country:US
Practice Address - Phone:406-665-2310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN30747163W00000X
MT101298207P00000X
MTNUR-APRN-LIC-101298363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine