Individual
BROOKE LEXENA LOGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
741 NE 6TH ST, GRANTS PASS, OR 97526-1556
(541) 471-2701
Mailing address
2045 HAVILAND DR, GRANTS PASS, OR 97527-5116
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA217205
OR
Other
Enumeration date
12/12/2023
Last updated
02/06/2024
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