Provider Demographics
NPI:1073324059
Name:LOGAN, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:LOGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56125 838 RD
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:NE
Mailing Address - Zip Code:68779-2113
Mailing Address - Country:US
Mailing Address - Phone:402-910-2266
Mailing Address - Fax:
Practice Address - Street 1:3100 23RD ST STE 25
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-3161
Practice Address - Country:US
Practice Address - Phone:402-564-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion