Healthcare Provider Details

I. General information

NPI: 1366569238
Provider Name (Legal Business Name): EVELYN LOGAN N.P., R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3812 N 1ST ST
FRESNO CA
93726-4301
US

IV. Provider business mailing address

7055 N MAPLE AVE 106
FRESNO CA
93720-8012
US

V. Phone/Fax

Practice location:
  • Phone: 559-495-3120
  • Fax: 559-495-3134
Mailing address:
  • Phone: 559-797-9800
  • Fax: 559-797-0140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberNP 5754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: