1972580801 NPI number — DR. JEANETTE AURAND LEGENZA MD

Table of content: DR. JEANETTE AURAND LEGENZA MD (NPI 1972580801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972580801 NPI number — DR. JEANETTE AURAND LEGENZA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEGENZA
Provider First Name:
JEANETTE
Provider Middle Name:
AURAND
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AURAND
Provider Other First Name:
JEANETTE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972580801
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4001 DALE ST
Provider Second Line Business Mailing Address:
STE 213
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99508-5428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-562-2944
Provider Business Mailing Address Fax Number:
907-562-6321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4001 DALE ST
Provider Second Line Business Practice Location Address:
STE 213
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99508-5428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-562-2944
Provider Business Practice Location Address Fax Number:
907-562-6321
Provider Enumeration Date:
12/30/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  5530 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MD5103 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".