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TIFFANY NICOLE LOGAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
1701 CURTIS RD, CHAMPAIGN, IL 61822-9678
(217) 365-6201
Mailing address
2302 BELMORE DR, CHAMPAIGN, IL 61821

Taxonomy

Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
209.021232
IL

Other

Enumeration date
05/17/2021
Last updated
12/08/2022
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