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NPI Code Detail

MEDICARE: MRS. SHAWNA MARISSA LOGAN APRN

MEDICARE: MRS. SHAWNA MARISSA LOGAN APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerR0074435OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063749018
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHAWNA MARISSA LOGAN APRN
Provider Business Mailing Address
First Line : 1101 HILLCREST DR
Second Line :
City : WOODWARD
State : OK
Zip : 73801-3027
Country : US
Telephone Number : 580-256-3608
Fax Number :
Provider Business Practice Location Address
First Line : 1101 HILLCREST DR
Second Line :
City : WOODWARD
State : OK
Zip : 73801-3027
Country : US
Telephone Number : 580-256-3608
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2009
Last Update Date : 10/29/2024

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