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General NPI Number Information
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NPI Number | 1710609391
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Entity Type | Individual
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Provider Name | TAWANDA LOGAN-HURT IBCLC
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Gender | Female
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 114 WARE ST
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City | SIDON
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State | MS
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Zip | 38954-6648
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Country | US
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Telephone | 662-458-2379
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 194
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City | SIDON
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State | MS
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Zip | 38954-0194
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Country | US
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Telephone | 662-458-2379
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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 | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number | L-306983
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License Number State | MS
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