Individual
LOGAN WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
134 HILLSIDE LN, WHITELAND, IN 46184-9683
(317) 650-0766
Mailing address
134 HILLSIDE LN, WHITELAND, IN 46184-9683
(317) 650-0766
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/29/2020
Last updated
07/29/2020
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