Provider Demographics
NPI:1215113782
Name:LOGAN, DEBORAH NOEL (CNM, NP)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:NOEL
Last Name:LOGAN
Suffix:
Gender:F
Credentials:CNM, NP
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:NOEL
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, NP
Mailing Address - Street 1:195 AVIATION WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2053
Mailing Address - Country:US
Mailing Address - Phone:831-728-8250
Mailing Address - Fax:831-707-2777
Practice Address - Street 1:204 E BEACH ST
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4809
Practice Address - Country:US
Practice Address - Phone:831-728-0222
Practice Address - Fax:831-707-2777
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN502794163W00000X
CANP13765363L00000X
CACNM1428367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner