Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | 103-20694 | DC |
Y | 363L00000X | Nurse Practitioner | RN45366 | DC |
NPI | 1316153042 |
---|---|
Provider Name | Ms. Kathleen Logan |
First Address | Rockville, MD 20852-4908 |
Second Address | Washington, DC 20002-7200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 03/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P88579 | (02) |