Healthcare Provider Details

I. General information

NPI: 1033666110
Provider Name (Legal Business Name): MEREDITH LEGG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 LONG SANDS RD
YORK ME
03909-1158
US

IV. Provider business mailing address

15 HOSPITAL DR
YORK ME
03909-1011
US

V. Phone/Fax

Practice location:
  • Phone: 207-351-3477
  • Fax:
Mailing address:
  • Phone: 207-363-4321
  • Fax: 207-363-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number341032
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN04042
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP201425
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: