Individual
LISA M LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1501 N CAMPBELL AVE, TUCSON, AZ 85724-0001
(520) 694-7432
(520) 694-6688
Mailing address
2701 E ELVIRA RD, TUCSON, AZ 85756-7124
(520) 874-3500
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
090013
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
407654
—
AZ
Enumeration date
01/05/2009
Last updated
05/07/2009
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