Individual
MS. ROBERTA HELEN LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
165 QUINCY ST, BROCKTON, MA 02302-2988
(774) 766-1452
Mailing address
165 QUINCY ST, BROCKTON, MA 02302-2988
(774) 766-1452
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
234569
MA
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
234569
MA
Other
Enumeration date
09/08/2009
Last updated
09/08/2009
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