Provider Demographics
NPI:1588092688
Name:LOGAN, DARLA LAVONE
Entity type:Individual
Prefix:
First Name:DARLA
Middle Name:LAVONE
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 1:7950 E ACOMA DR
Mailing Address - Street 2:STE 207
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6964
Mailing Address - Country:US
Mailing Address - Phone:623-396-6107
Mailing Address - Fax:480-393-0407
Practice Address - Street 1:14300 N NORTHSIGHT BLVD
Practice Address - Street 2:#214
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3672
Practice Address - Country:US
Practice Address - Phone:623-396-6107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13-1403175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath