Provider Demographics
NPI:1477994804
Name:LOGUE, LISA CLAIR (FNP-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:CLAIR
Last Name:LOGUE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:CLAIR
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 WATERFRONT PARK LN
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-5775
Mailing Address - Country:US
Mailing Address - Phone:770-500-0213
Mailing Address - Fax:
Practice Address - Street 1:725 JESSE JEWELL PKWY SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3834
Practice Address - Country:US
Practice Address - Phone:770-536-2323
Practice Address - Fax:770-536-4947
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN049489163WX0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WX0200XNursing Service ProvidersRegistered NurseOncology