Provider Demographics
NPI:1124514120
Name:LOGAN, HOLLY RAE (MSN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:RAE
Last Name:LOGAN
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 LOGAN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-1288
Mailing Address - Country:US
Mailing Address - Phone:207-557-1297
Mailing Address - Fax:
Practice Address - Street 1:121 MEDICAL CENTER DR STE 2600
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2668
Practice Address - Country:US
Practice Address - Phone:207-721-8333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP181101363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily