Provider Demographics
NPI:1598039984
Name:LOGAN, JENNIFER DAWN (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DAWN
Last Name:LOGAN
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:DAWN
Other - Last Name:LOWERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP-BC
Mailing Address - Street 1:PO BOX 820852
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-0019
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11802 NE 65TH ST STE 100
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-5521
Practice Address - Country:US
Practice Address - Phone:360-253-6883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2024-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61131815363LF0000X
WVAPRN101674363LF0000X
NY344080363LF0000X
COC-APN.0101436-C-NP363LF0000X
OR201810264NP-PP363LF0000X
FLRN9252175163W00000X
FLARNP9252175363L00000X
AZ312019363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
1598039984OtherNPI NUMBER