Healthcare Provider Details

I. General information

NPI: 1518656529
Provider Name (Legal Business Name): GINAMARIE LOGRANDE MS, CNS CANDIDATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 S TOPAZ PL
CHANDLER AZ
85249-5452
US

IV. Provider business mailing address

3961 E CHANDLER BLVD STE 111-213
PHOENIX AZ
85048-0303
US

V. Phone/Fax

Practice location:
  • Phone: 602-643-8134
  • Fax:
Mailing address:
  • Phone: 602-643-8134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: