Individual
JENNIFER LEIGH LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 916-2600
Mailing address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 916-2600
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
4704257643
MI
363LG0600X
Gerontology Nurse Practitioner
4704257643
MI
363LP2300X
Primary Care Nurse Practitioner
Primary
4704257643
MI
Other
Enumeration date
09/12/2016
Last updated
02/15/2021
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