Individual
MR. LOGAN MICHAEL BUSTOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
101 S. PARKVIEW ST., COFFEYVILLE, KS 67337
(620) 252-8766
Mailing address
101 S. PARKVIEW ST., COFFEYVILLE, KS 67337
(620) 252-8766
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
213377
OK
Other
Enumeration date
08/12/2022
Last updated
03/04/2024
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