Provider Demographics
NPI:1780949636
Name:LEGTERS, FERN (LAC)
Entity type:Individual
Prefix:
First Name:FERN
Middle Name:
Last Name:LEGTERS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7374 GAUSS RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14469-9370
Mailing Address - Country:US
Mailing Address - Phone:585-657-6033
Mailing Address - Fax:
Practice Address - Street 1:7374 GAUSS ROAD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NY
Practice Address - Zip Code:14469
Practice Address - Country:US
Practice Address - Phone:585-657-6033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004834-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist