Provider Demographics
NPI:1013367507
Name:LOGUE, GAIL R (NP)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:R
Last Name:LOGUE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:
Other - Last Name:HUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1120 E ELIZABETH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4044
Mailing Address - Country:US
Mailing Address - Phone:970-493-9193
Mailing Address - Fax:
Practice Address - Street 1:1120 E ELIZABETH ST STE 2
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4044
Practice Address - Country:US
Practice Address - Phone:970-493-9193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0117095163W00000X
NMCNP-63996363LF0000X
COAPN.0002856-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse