Individual
LOGAN WADDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
2707 BROWNS LN, JONESBORO, AR 72401-7213
(870) 972-4939
Mailing address
2707 BROWNS LN, JONESBORO, AR 72401-7213
(870) 972-4939
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L054172
AR
Other
Enumeration date
09/23/2013
Last updated
09/23/2013
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