Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 137404 | MA |
NPI | 1053342360 |
---|---|
Provider Name | Ms. Anne M Logan |
First Address | Waltham, MA 02452-7808 |
Second Address | Bedford, MA 01730-1114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 08/07/2007 |