Healthcare Provider Details

I. General information

NPI: 1316153042
Provider Name (Legal Business Name): KATHLEEN LOGAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 17TH ST NE COMMUNITY OF HOPE AT FAMILY HEALTH AND BIRTH CENTER
WASHINGTON DC
20002-7200
US

IV. Provider business mailing address

2101 E JEFFERSON ST KAISER PERMANENTE MEDICARE ENROLLMENT
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 202-398-5520
  • Fax:
Mailing address:
  • Phone: 301-816-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN45366
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number103-20694
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: