Individual
MRS. SALLY STEPHENS LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
1732 BUCKLEY ARCH, VIRGINIA BEACH, VA 23453-7081
(757) 430-8256
Mailing address
1732 BUCKLEY ARCH, VIRGINIA BEACH, VA 23453-7081
(757) 430-8256
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
448386
REGISTRATION NUMBER
—
Enumeration date
11/12/2007
Last updated
11/12/2007
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