Individual
LOGAN TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
20733 N BROAD ST, CARLINVILLE, IL 62626-1499
(217) 854-3141
(217) 625-1005
Mailing address
20733 N BROAD ST, CARLINVILLE, IL 62626-1499
(215) 854-3141
(217) 625-1005
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209.013798
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209009995
IL
Other
Enumeration date
02/11/2016
Last updated
12/02/2024
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