Provider Demographics
NPI:1124420328
Name:LEGERE, HILLARY (RD)
Entity type:Individual
Prefix:
First Name:HILLARY
Middle Name:
Last Name:LEGERE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:HILLARY
Other - Middle Name:
Other - Last Name:O'DONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:144 STATE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3776
Mailing Address - Country:US
Mailing Address - Phone:207-400-8500
Mailing Address - Fax:207-400-8508
Practice Address - Street 1:144 STATE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3776
Practice Address - Country:US
Practice Address - Phone:207-400-8500
Practice Address - Fax:207-400-8508
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI1162133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered