Healthcare Provider Details

I. General information

NPI: 1972580801
Provider Name (Legal Business Name): JEANETTE AURAND LEGENZA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEANETTE MARIE AURAND MD

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 DALE ST STE 213
ANCHORAGE AK
99508-5428
US

IV. Provider business mailing address

4001 DALE ST STE 213
ANCHORAGE AK
99508-5428
US

V. Phone/Fax

Practice location:
  • Phone: 907-562-2944
  • Fax: 907-562-6321
Mailing address:
  • Phone: 907-562-2944
  • Fax: 907-562-6321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5530
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierMD5103
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: