=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508744947
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LOGAN WEIR CNM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2025
-----------------------------------------------------
Last Update Date | 01/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2928 N 18TH PL
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85016-7705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-256-7766
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 707 N APACHE DR
-----------------------------------------------------
City | DEWEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86327-5702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-256-7766
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number | 221863
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------