Provider Demographics
NPI:1104311125
Name:LOGAN, BRANTRESS NICOLE
Entity type:Individual
Prefix:
First Name:BRANTRESS
Middle Name:NICOLE
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 1:885 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-1148
Mailing Address - Country:US
Mailing Address - Phone:330-256-4526
Mailing Address - Fax:
Practice Address - Street 1:885 SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-1148
Practice Address - Country:US
Practice Address - Phone:330-256-4526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health