Healthcare Provider Details

I. General information

NPI: 1508744947
Provider Name (Legal Business Name): LOGAN WEIR CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2928 N 18TH PL
PHOENIX AZ
85016-7705
US

IV. Provider business mailing address

707 N APACHE DR
DEWEY AZ
86327-5702
US

V. Phone/Fax

Practice location:
  • Phone: 602-256-7766
  • Fax:
Mailing address:
  • Phone: 602-256-7766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number221863
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: