MEDICARE: ERIKA LOGAN PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN2263578	MA
2	163WP0808X	Psychiatric/Mental Health Registered Nurse	RN2263578	MA

General Provider Information

NPI Number	:	1548771264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA LOGAN PMHNP

Provider Business Mailing Address
First Line	:	38 MAPLEWOOD RD
Second Line	:
City	:	PEMBROKE
State	:	MA
Zip	:	02359-3110
Country	:	US
Telephone Number	:	781-217-1950
Fax Number	:	781-217-1950

Provider Business Practice Location Address
First Line	:	2 GRANITE AVE
Second Line	:
City	:	MILTON
State	:	MA
Zip	:	02186-4376
Country	:	US
Telephone Number	:	781-217-1950
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2017
Last Update Date	:	06/17/2025

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