Healthcare Provider Details

I. General information

NPI: 1336070093
Provider Name (Legal Business Name): ANABEL HOPE LOGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 NE STUCKI AVE STE 270
BEAVERTON OR
97006-6950
US

IV. Provider business mailing address

1925 NE STUCKI AVE STE 270
BEAVERTON OR
97006-6950
US

V. Phone/Fax

Practice location:
  • Phone: 971-300-0654
  • Fax:
Mailing address:
  • Phone: 971-300-0654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10059521
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: