Individual
MR. LOGAN NIELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
382 N OVERLAND AVE, BURLEY, ID 83318-3433
(208) 678-6996
Mailing address
300 DENNIS DR, BURLEY, ID 83318-3217
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
ID
Other
Enumeration date
10/10/2018
Last updated
10/10/2018
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