Healthcare Provider Details

I. General information

NPI: 1316850969
Provider Name (Legal Business Name): LATRICE LOGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S POTOMAC ST
AURORA CO
80012-5405
US

IV. Provider business mailing address

1700 S POTOMAC ST
AURORA CO
80012-5405
US

V. Phone/Fax

Practice location:
  • Phone: 303-418-7600
  • Fax: 303-750-3137
Mailing address:
  • Phone: 303-418-7600
  • Fax: 303-750-3137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number123733
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: