Organization
IVAN LEGOAS CRNA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IVAN LEGOAS CRNA (OWNER)
(574) 268-9640
Entity
Organization
Contact information
Practice address
9002 N MERIDIAN ST, LOWER LEVEL, INDIANAPOLIS, IN 46260-5381
(574) 268-9640
(574) 268-0684
Mailing address
PO BOX 1296, WARSAW, IN 46581-1296
(574) 268-9640
(574) 268-0684
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28139740A
STATE LICENSE
IN
Enumeration date
10/17/2014
Last updated
10/17/2014
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