Healthcare Provider Details

I. General information

NPI: 1558931261
Provider Name (Legal Business Name): LOGAN MEISINGER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2021
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N LINCOLN AVE
YORK NE
68467-1030
US

IV. Provider business mailing address

826 S COWAN AVE
YORK NE
68467-4112
US

V. Phone/Fax

Practice location:
  • Phone: 402-362-6671
  • Fax:
Mailing address:
  • Phone: 402-710-9089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101698
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number82177
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: