Healthcare Provider Details

I. General information

NPI: 1598039984
Provider Name (Legal Business Name): JENNIFER DAWN LOGAN APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER DAWN LOWERY APRN, FNP-BC

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 12/08/2024
Certification Date: 12/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11802 NE 65TH ST STE 100
VANCOUVER WA
98662-5521
US

IV. Provider business mailing address

PO BOX 820852
VANCOUVER WA
98682-0019
US

V. Phone/Fax

Practice location:
  • Phone: 360-253-6883
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9252175
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61131815
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN101674
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number344080
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberC-APN.0101436-C-NP
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201810264NP-PP
License Number StateOR
# 7
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number312019
License Number StateAZ
# 8
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9252175
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: