Healthcare Provider Details

I. General information

NPI: 1689284515
Provider Name (Legal Business Name): SAVANNAH NICOLE LOGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 LINN ST
CINCINNATI OH
45203-1314
US

IV. Provider business mailing address

3250 JEFFERSON AVE APT 207
CINCINNATI OH
45220-2993
US

V. Phone/Fax

Practice location:
  • Phone: 513-233-7100
  • Fax:
Mailing address:
  • Phone: 330-639-9322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: