Healthcare Provider Details

I. General information

NPI: 1215113782
Provider Name (Legal Business Name): DEBORAH NOEL LOGAN CNM, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH NOEL LARSON CNM, NP

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E BEACH ST
WATSONVILLE CA
95076-4809
US

IV. Provider business mailing address

195 AVIATION WAY SUITE 200
WATSONVILLE CA
95076-2053
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-0222
  • Fax: 831-707-2777
Mailing address:
  • Phone: 831-728-8250
  • Fax: 831-707-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN502794
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP13765
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM1428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: