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General NPI Number Information
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NPI Number | 1790410603
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Entity Type | Individual
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Provider Name | JENNIFER LOGAN MSN APRN FNP PMHNP
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Gender | Female
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Dates
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Enumeration Date | 07/24/2022
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 43 NEW SCOTLAND AVE # M506
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City | ALBANY
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State | NY
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Zip | 12208-3478
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Country | US
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Telephone | 518-262-0526
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Fax |
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Provider Business Mailing Address
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Address Line | 22 ROSEMONT ST
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City | ALBANY
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State | NY
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Zip | 12203-2405
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Country | US
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Telephone | 802-236-2611
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 405414
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 348057
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License Number State | NY
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