Individual
LOGAN ANN JENNINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9197 GRANT ST, SUITE 200, THORNTON, CO 80229-4329
(303) 450-3690
(303) 962-1511
Mailing address
9197 GRANT ST, SUITE 200, THORNTON, CO 80229-4329
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
4312
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4312
LICENSE
CO
Enumeration date
07/29/2015
Last updated
06/16/2020
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