Healthcare Provider Details

I. General information

NPI: 1508390006
Provider Name (Legal Business Name): CLAUDIA M LOGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 08/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 OXFORD CT
BELLEVILLE MI
48111-4927
US

IV. Provider business mailing address

305 OXFORD CT
BELLEVILLE MI
48111-4927
US

V. Phone/Fax

Practice location:
  • Phone: 734-922-5142
  • Fax:
Mailing address:
  • Phone: 734-922-5142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number230361320797
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: