Provider Demographics
NPI:1962748996
Name:LOGUIDICE, ALICE GAIL (CPNP)
Entity type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:GAIL
Last Name:LOGUIDICE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 WINGO WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-1804
Mailing Address - Country:US
Mailing Address - Phone:843-881-2484
Mailing Address - Fax:
Practice Address - Street 1:309 WINGO WAY
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-1804
Practice Address - Country:US
Practice Address - Phone:843-881-2484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN.18053363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics