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NPI Code Detail

MEDICARE: AYESHA NICOLE LOGAN CRNP

MEDICARE: AYESHA NICOLE LOGAN CRNP
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerSP032916PA

General Provider Information

NPI Number : 1134085954
Entity Type Code : Individual
Provider Name (Legal Business Name) : AYESHA NICOLE LOGAN CRNP
Provider Business Mailing Address
First Line : 561 FAIRTHORNE AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19128-2412
Country : US
Telephone Number : 215-487-4000
Fax Number :
Provider Business Practice Location Address
First Line : 561 FAIRTHORNE AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19128-2412
Country : US
Telephone Number : 215-487-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/26/2025
Last Update Date : 01/11/2026

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Directions to “ AYESHA NICOLE LOGAN CRNP” Practice Location

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