Provider Demographics
NPI:1366569238
Name:LOGAN, EVELYN (NP, RN)
Entity type:Individual
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First Name:EVELYN
Middle Name:
Last Name:LOGAN
Suffix:
Gender:F
Credentials:NP, RN
Other - Prefix:
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Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:7055 N MAPLE AVE
Mailing Address - Street 2:106
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-8012
Mailing Address - Country:US
Mailing Address - Phone:559-797-9800
Mailing Address - Fax:559-797-0140
Practice Address - Street 1:3812 N 1ST ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-4301
Practice Address - Country:US
Practice Address - Phone:559-495-3120
Practice Address - Fax:559-495-3134
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP 5754363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN 271957OtherRN LICENSE #
CANP 5754OtherNURSE PRACT LICENSE #