Healthcare Provider Details

I. General information

NPI: 1548740111
Provider Name (Legal Business Name): DOREEN M LEGERE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UK DIVISION OF PULMONARY CRITICAL CARE 800 ROSE ST
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

740 S LIMESTONE L543
LEXINGTON KY
40536-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3012608
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number3012608
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: