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General NPI Number Information
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NPI Number | 1114594876
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Entity Type | Individual
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Provider Name | LOGAN ALISSA DANZELL CRNA
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Gender | Female
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Dates
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Enumeration Date | 06/09/2021
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 5 RICHLAND MEDICAL PARK DR
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City | COLUMBIA
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State | SC
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Zip | 29203-6863
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Country | US
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Telephone | 843-715-1860
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 840853
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City | DALLAS
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State | TX
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Zip | 75284-8781
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Country | US
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Telephone | 972-233-1999
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Fax | 972-233-3666
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 1127014
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License Number State | TX
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