Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A 8230 | CA |
NPI | 1407092034 |
---|---|
Provider Name | Dr. Jennifer Anne Logan |
First Address | Palo Alto, CA 94301-1345 |
Second Address | Palo Alto, CA 94301-1345 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2009 |
Last Update Date | 03/01/2009 |