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General NPI Number Information
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NPI Number | 1811616246
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Entity Type | Individual
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Provider Name | RALPH JAMES LOGAN NP
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Gender | Male
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Dates
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Enumeration Date | 08/29/2022
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Last Update Date | 01/10/2023
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Provider Practice Location Address
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Address Line | 326 WASHINGTON ST
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City | NORWICH
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State | CT
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Zip | 06360-2740
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Country | US
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Telephone | 860-889-8331
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Fax |
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Provider Business Mailing Address
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Address Line | 61 ATTAWAN RD
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City | NIANTIC
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State | CT
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Zip | 06357-3635
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Country | US
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Telephone | 845-222-4246
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | F432281-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 11387
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License Number State | CT
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