| NPI | 1477221778 |
|---|---|
| Former Name | LOGAN RAYMOND |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-81205-012) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2021037519) |
| Enumeration Date | 2021-09-01 |
| Last Update Date | 2024-09-24 |