| NPI | 1780128207 |
|---|---|
| Former Name | BRANDI NICOLE LOGA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MA058804) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA058804) |
| Enumeration Date | 2016-12-19 |
| Last Update Date | 2018-02-06 |