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Individual
LAZEDRICK LOGAN
Active
Individual
LAZEDRICK LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
1032186
TX
163WP0808X
Psychiatric/Mental Health Registered Nurse
829535
CA
363L00000X
Nurse Practitioner
95008515
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1032186
TX
Other
Enumeration date
08/30/2017
Last updated
09/17/2022
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