Individual
JESSICA J LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
200 NW AVENUE M APT 811, ANDREWS, TX 79714-3536
(402) 359-3612
Mailing address
200 NW AVENUE M APT 811, ANDREWS, TX 79714-3536
(402) 359-3612
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
320380
TX
Other
Enumeration date
12/22/2023
Last updated
12/22/2023
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