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NPI Code Detail

MEDICARE: LINDA S LOGAN CRNA

MEDICARE: LINDA S LOGAN CRNA
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
1163W00000XRegistered NurseRN-135649OH
2367500000XCertified Registered Nurse AnesthetistCOA.00492-NAOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
211894927OTHEROHCAQH

General Provider Information

NPI Number : 1073562807
Entity Type Code : Individual
Provider Name (Legal Business Name) : LINDA S LOGAN CRNA
Provider Business Mailing Address
First Line : 3622 BELMONT AVE
Second Line : SUITE 1
City : YOUNGSTOWN
State : OH
Zip : 44505-1450
Country : US
Telephone Number : 330-759-9350
Fax Number : 330-759-9387
Provider Business Practice Location Address
First Line : 3893 E MARKET ST
Second Line :
City : WARREN
State : OH
Zip : 44484-4706
Country : US
Telephone Number : 330-856-1272
Fax Number : 330-856-2960
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2006
Last Update Date : 03/17/2011

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Directions to “ LINDA S LOGAN CRNA” Practice Location

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