MEDICARE: LILY ANNE LOGAN

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
1	374J00000X	Doula

General Provider Information

NPI Number	:	1376402883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILY ANNE LOGAN

Provider Business Mailing Address
First Line	:	1908 COYOTE PASS WAY
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-2160
Country	:	US
Telephone Number	:	702-419-1915
Fax Number	:

Provider Business Practice Location Address
First Line	:	1908 COYOTE PASS WAY
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-2160
Country	:	US
Telephone Number	:	702-419-1915
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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Directions to “ LILY ANNE LOGAN ” Practice Location

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