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Individual
MARY J LOGSDON
Active
Individual
MARY J LOGSDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
145910
MO
363LF0000X
Family Nurse Practitioner
209008143
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
137710005
MEDICARE
MO
Enumeration date
04/03/2009
Last updated
07/22/2016
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