MEDICARE: DEBORAH LOGAN DBA BIRTH AND BEYOND

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	367A00000X	Advanced Practice Midwife	431	NM

Other Identifiers

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

General Provider Information

NPI Number	:	1679628622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEBORAH LOGAN DBA BIRTH AND BEYOND

Provider Business Mailing Address
First Line	:	2906 HILLRISE DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4702
Country	:	US
Telephone Number	:	575-521-4273
Fax Number	:	575-521-7777

Provider Business Practice Location Address
First Line	:	2906 HILLRISE DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4702
Country	:	US
Telephone Number	:	575-521-4273
Fax Number	:	575-521-7777

Authorized Official
Title or Position	:	OWNER
Name	:	DEBORAH LOGAN
Credential	:	CNM
Telephone Number	:	575-521-4273

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	06/13/2008

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