Individual
MARKEISHA L LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
104 JUNGERMANN RD # F, SAINT PETERS, MO 63376-1608
(636) 244-2112
Mailing address
104 JUNGERMANN RD # F, SAINT PETERS, MO 63376-1608
(636) 244-2112
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
1437
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
821091387
—
MO
Enumeration date
10/16/2019
Last updated
10/16/2019
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