1548416027 NPI number — MRS. JUDITH M LOGAN RNFA

Table of content: MRS. JUDITH M LOGAN RNFA (NPI 1548416027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548416027 NPI number — MRS. JUDITH M LOGAN RNFA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOGAN
Provider First Name:
JUDITH
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RNFA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548416027
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5315 DUNLEIGH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22015-1650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-978-0005
Provider Business Mailing Address Fax Number:
703-978-0005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9300 DEWITT LOOP
Provider Second Line Business Practice Location Address:
FORT BELVOIR COMMUNITY HOSPITAL
Provider Business Practice Location Address City Name:
FORT BELVOIR
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-231-3363
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WR0006X , with the licence number:  075631 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 075631 . This is a "RN LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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