Provider Demographics
NPI:1124343306
Name:LEGENDRE, COURTNEY DAWN (PA-C)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:DAWN
Last Name:LEGENDRE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 420
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:DR. HITZELBERGER STRASSE
Practice Address - Street 2:
Practice Address - City:LANDSTUHL
Practice Address - State:KIRCHBERG,
Practice Address - Zip Code:66849
Practice Address - Country:DE
Practice Address - Phone:314-537-0058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1091554363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant