Provider Demographics
NPI:1730507245
Name:LEGISTER, OLIVER (LPN)
Entity type:Individual
Prefix:
First Name:OLIVER
Middle Name:
Last Name:LEGISTER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 PEARSALL AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5009
Mailing Address - Country:US
Mailing Address - Phone:203-502-9655
Mailing Address - Fax:
Practice Address - Street 1:3208 PEARSALL AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5009
Practice Address - Country:US
Practice Address - Phone:203-502-9655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315338164W00000X
CT037069164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse