Individual
LOGAN ALISSA DANZELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
5 RICHLAND MEDICAL PARK DR, COLUMBIA, SC 29203-6863
(843) 715-1860
Mailing address
PO BOX 840853, DALLAS, TX 75284-8781
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1127014
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZCW225506415229
BLUE CROSS BLUE SHIELD
SC
Enumeration date
06/09/2021
Last updated
08/02/2023
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