Healthcare Provider Details

I. General information

NPI: 1619316627
Provider Name (Legal Business Name): LOGAN EVANS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5210 190TH ST
ARMSTRONG IA
50514-7546
US

IV. Provider business mailing address

5210 190TH ST
ARMSTRONG IA
50514-7546
US

V. Phone/Fax

Practice location:
  • Phone: 712-866-2434
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number203618-2
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: