=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396229613
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALISA LOGAR FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2018
-----------------------------------------------------
Last Update Date | 11/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 W PENNSYLVANIA AVE
-----------------------------------------------------
City | ANACONDA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59711-1931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-563-8540
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 W PENNSYLVANIA AVE
-----------------------------------------------------
City | ANACONDA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59711-1999
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-563-8540
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | NUR-APRN-LIC-143844
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | NUR-RN-LIC-74954
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------