Healthcare Provider Details

I. General information

NPI: 1508916180
Provider Name (Legal Business Name): DEBORAH P LOGAN RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE WARD 93
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

102 FRANZ CT # 1
PACIFICA CA
94044-3028
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-5239
  • Fax:
Mailing address:
  • Phone: 415-206-5239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number435789
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number1168
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: