Individual
LOGAN FAYE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7422 COUNTY ROAD 1480, ADA, OK 74820-0531
(580) 279-3376
Mailing address
7422 COUNTY ROAD 1480, ADA, OK 74820-0531
(580) 279-3376
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
02/12/2014
Last updated
02/12/2014
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