Provider Demographics
NPI:1740652411
Name:LEGETTE, YVONNE
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:LEGETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 E 19TH ST
Mailing Address - Street 2:6-C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4884
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:119 E 19TH ST
Practice Address - Street 2:6-C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4884
Practice Address - Country:US
Practice Address - Phone:718-666-6724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236179164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse