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General NPI Number Information
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NPI Number | 1194618959
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Entity Type | Individual
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Provider Name | MRS. BRIANNA ALIZAE LOGAN
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Gender | Female
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Dates
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Enumeration Date | 05/31/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 100 KENYON AVE
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City | WAKEFIELD
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State | RI
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Zip | 02879-4299
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Country | US
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Telephone | 401-782-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 372 PONTIAC AVE
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City | CRANSTON
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State | RI
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Zip | 02910-2707
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Country | US
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Telephone | 401-345-1361
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | APRN04735
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License Number State | RI
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