Organization
LOGAN FAMILY PRACTICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAJUANA DELL WILLIS CFNP (MEMBER)
(575) 487-9000
Entity
Organization
Contact information
Practice address
600 GALLEGOS, LOGAN, NM 88426-7602
(575) 487-9000
(575) 487-9002
Mailing address
600 GALLEGOS, LOGAN, NM 88426-7602
(575) 487-9000
(575) 487-9002
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
R14626
NM
363LF0000X
Family Nurse Practitioner
R14626
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
28184564
—
NM
Enumeration date
02/04/2009
Last updated
02/23/2014
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