Healthcare Provider Details

I. General information

NPI: 1477559805
Provider Name (Legal Business Name): MARGARET B LOGAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102A ASTOR ST
WELLFORD SC
29385-9622
US

IV. Provider business mailing address

102A ASTOR ST
WELLFORD SC
29385-9622
US

V. Phone/Fax

Practice location:
  • Phone: 864-439-5338
  • Fax: 864-439-4769
Mailing address:
  • Phone: 864-439-5338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN1908
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: