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General NPI Number Information
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NPI Number | 1386021160
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Entity Type | Individual
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Provider Name | DONNA RENAE LOGAN CRNP
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Gender | Female
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Dates
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Enumeration Date | 04/30/2015
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Last Update Date | 04/30/2015
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Provider Practice Location Address
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Address Line | 100 E CARROLL ST
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City | SALISBURY
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State | MD
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Zip | 21801-5422
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Country | US
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Telephone | 410-456-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 27011 BARRINGTON RIDGE DR
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City | SALISBURY
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State | MD
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Zip | 21801-1600
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Country | US
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Telephone | 410-341-7307
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | R145078
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License Number State | MD
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