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General NPI Number Information
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NPI Number | 1548416027
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Entity Type | Individual
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Provider Name | JUDITH M LOGAN RNFA
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Gender | Female
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Dates
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Enumeration Date | 08/15/2008
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | 9300 DEWITT LOOP FORT BELVOIR COMMUNITY HOSPITAL
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City | FORT BELVOIR
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State | VA
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Zip | 22060
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Country | US
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Telephone | 571-231-3363
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Fax |
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Provider Business Mailing Address
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Address Line | 5315 DUNLEIGH DR
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City | BURKE
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State | VA
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Zip | 22015-1650
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Country | US
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Telephone | 703-978-0005
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Fax | 703-978-0005
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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 | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | 075631
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License Number State | AZ
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