Individual
LEKISHA ANTIONETTE LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1170 FAIRGROVE CHURCH RD, HICKORY, NC 28602-9695
(828) 464-1172
Mailing address
515 CLANTON RD, CHARLOTTE, NC 28217-1309
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
75581
NC
Other
Enumeration date
07/10/2014
Last updated
07/10/2014
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