Organization
LEGENDMED PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH JORDAN WHITING CRNA (OWNER)
(512) 201-9957
Entity
Organization
Contact information
Practice address
140 N LITCHFIELD RD STE 110, GOODYEAR, AZ 85338-1226
(602) 256-2525
Mailing address
PO BOX 3394, IDAHO FALLS, ID 83403-3394
(208) 525-2090
(208) 523-8978
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
08/12/2021
Last updated
08/12/2021
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