Individual
EBONY LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3700 W KILGORE AVE, MUNCIE, IN 47304-4810
(765) 289-5437
Mailing address
3701 SHELBY ST APT 423, INDIANAPOLIS, IN 46227-3413
(540) 293-0690
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/22/2020
Last updated
05/22/2020
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