Provider Demographics
NPI:1487366670
Name:LEGACIE, LOIS ANN
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:ANN
Last Name:LEGACIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10858 64TH ST NE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:ND
Mailing Address - Zip Code:58345-9683
Mailing Address - Country:US
Mailing Address - Phone:701-351-2779
Mailing Address - Fax:
Practice Address - Street 1:601 6TH ST W
Practice Address - Street 2:
Practice Address - City:LAKOTA
Practice Address - State:ND
Practice Address - Zip Code:58344-7301
Practice Address - Country:US
Practice Address - Phone:701-230-4973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant