Healthcare Provider Details

I. General information

NPI: 1740191519
Provider Name (Legal Business Name): LOGAN MCKENZIE NEAL AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 NE 139TH ST STE 245
VANCOUVER WA
98686-2302
US

IV. Provider business mailing address

2121 NE 139TH ST STE 245
VANCOUVER WA
98686-2302
US

V. Phone/Fax

Practice location:
  • Phone: 360-487-1020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number10066691
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: