Individual
PAUL LOGAN
Active
Individual
PAUL LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN316830L
PA
363L00000X
Nurse Practitioner
TP003104P
PA
363LA2100X
Acute Care Nurse Practitioner
Primary
TP003104P
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007330053
—
PA
01
—
14046796
CAQH
PA
Enumeration date
09/26/2006
Last updated
09/08/2021
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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