Healthcare Provider Details

I. General information

NPI: 1023740354
Provider Name (Legal Business Name): FATMA LEGNAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W 12TH AVE FL 2
COLUMBUS OH
43210-1267
US

IV. Provider business mailing address

4857 ROBERTS RD APT 101
COLUMBUS OH
43228-9874
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-2622
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number004526
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: