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General NPI Number Information
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NPI Number | 1053342360
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Entity Type | Individual
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Provider Name | ANNE M LOGAN NP
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Gender | Female
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 200 SPRINGS RD
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City | BEDFORD
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State | MA
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Zip | 01730-1114
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Country | US
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Telephone | 781-687-2430
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Fax |
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Provider Business Mailing Address
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Address Line | 68 TEMPLE RD
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City | WALTHAM
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State | MA
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Zip | 02452-7808
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Country | US
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Telephone | 781-893-7712
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 137404
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License Number State | MA
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