Healthcare Provider Details

I. General information

NPI: 1689412686
Provider Name (Legal Business Name): LOGAN EDWARD MOORE DNP, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U.S. NAVAL HOSPITAL OKINAWA PSC 482
FPO AP
96362
US

IV. Provider business mailing address

4301 JONES BRIDGE RD
BETHESDA MD
20814-4799
US

V. Phone/Fax

Practice location:
  • Phone: 98-971-7555
  • Fax:
Mailing address:
  • Phone: 800-515-5257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP.AP.70137485-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: