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General NPI Number Information
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NPI Number | 1669022240
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Entity Type | Individual
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Provider Name | ADELL LOGAN FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/16/2019
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 7130 MINSTREL WAY STE 230
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City | COLUMBIA
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State | MD
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Zip | 21045-5339
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Country | US
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Telephone | 443-804-2788
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Fax |
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Provider Business Mailing Address
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Address Line | 6745 EASTERN HILLS ST
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City | HUGHESVILLE
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State | MD
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Zip | 20637-2953
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Country | US
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Telephone | 803-518-7491
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R185640
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License Number State | MD
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