Shawnee B Legarreta, RN
Individual provider Active NPI Substance Abuse Rehabilitation Facility · Gooding, ID
NPI 1235533217 · NPPES record last updated Oct 20, 2014
Key facts
- NPI
- 1235533217
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Substance Abuse Rehabilitation Facility 324500000X
- License
- N45891 (ID)
- Practice address
- 605 11TH Ave E
Gooding, ID 83330-5368 - Phone
- (208) 934-8461
- Fax
- (208) 934-5437
- NPI assigned
- Oct 20, 2014
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| N45891 | ID | MD | Substance Abuse Rehabilitation Facility |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Abuse Rehabilitation Facility | 324500000X | N45891 | ID | Yes |
Addresses
Primary practice location
605 11TH Ave E
Gooding, ID 83330-5368
Mailing address
605 11TH Ave E
Gooding, ID 83330-5368
Phone (208) 934-8461
Other providers in Gooding, ID
- Merri Ann King
- Brandon Douglas Knight
- Jeffrey Koudelka
- Sydney Kulhanek
- Shelby Lancaster
- Cheyanna Christine Lierman
- Danielle Macarthur Lofgran
- Reid Wayne Lofgran
- Heather Manning
- Mark C. Lambert, DMD PC
All providers in Gooding, ID · Substance Abuse Rehabilitation Facility in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 20, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.