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General NPI Number Information
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NPI Number | 1588305874
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Entity Type | Individual
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Provider Name | LOGAN M CANTERBURY
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Gender | Female
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Dates
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Enumeration Date | 04/02/2022
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Last Update Date | 07/02/2024
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Provider Practice Location Address
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Address Line | 2201 LEXINGTON AVE
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City | ASHLAND
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State | KY
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Zip | 41101-2843
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Country | US
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Telephone | 606-408-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 3944 8TH STREET RD
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City | HUNTINGTON
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State | WV
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Zip | 25701-9435
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Country | US
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Telephone | 304-544-4170
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 4023022
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License Number State | KY
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