Individual
MR. RICKEY LOGAN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PNP
Contact information
Practice address
550 1ST AVE, NEW YORK, NY 10016-6402
(513) 706-8109
Mailing address
550 1ST AVE, NEW YORK, NY 10016-6402
Taxonomy
Speciality
Code
Description
License number
State
363LP0222X
Critical Care Pediatric Nurse Practitioner
Primary
382652
NY
Other
Enumeration date
07/08/2016
Last updated
07/08/2016
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