Provider Demographics
NPI:1194797159
Name:LEGERE, WILLIAM ALFRED (FNP, PMHNP)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALFRED
Last Name:LEGERE
Suffix:
Gender:M
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1638
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12201-1638
Mailing Address - Country:US
Mailing Address - Phone:207-777-4111
Mailing Address - Fax:207-783-6660
Practice Address - Street 1:21 MILLETT DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-4055
Practice Address - Country:US
Practice Address - Phone:207-783-0018
Practice Address - Fax:207-783-0019
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME038298363L00000X
MECNP81487363LA2100X, 363LF0000X
MEAP081487363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1194797159Medicaid
MEP11516Medicare UPIN
MEUX3533Medicare PIN