Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | R029750 | ME |
NPI | 1730275116 |
---|---|
Provider Name | Ms. Barbara F Logue |
First Address | Southwest Harbor, ME 04679-0575 |
Second Address | Bar Harbor, ME 04609-1625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 07/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R029750 | MAINE LICENSE (01) | ME |