Provider Demographics
NPI:1417781956
Name:LEGRAND, ELLEN KATHLEEN (DNP, APN, AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:KATHLEEN
Last Name:LEGRAND
Suffix:
Gender:F
Credentials:DNP, APN, AGPCNP-BC
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:KATHLEEN
Other - Last Name:DANFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:1188 JACKSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NJ
Mailing Address - Zip Code:08022-1922
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1865 ROUTE 70 E
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2005
Practice Address - Country:US
Practice Address - Phone:800-789-7366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15123100363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care