Provider Demographics
NPI:1013550425
Name:MINKEVITCH, LOGAN RENAE (APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LOGAN
Middle Name:RENAE
Last Name:MINKEVITCH
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:LOGAN
Other - Middle Name:RENAE
Other - Last Name:DUERKSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:720 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-8778
Mailing Address - Country:US
Mailing Address - Phone:316-283-6103
Mailing Address - Fax:
Practice Address - Street 1:126 MAIN ST
Practice Address - Street 2:
Practice Address - City:HALSTEAD
Practice Address - State:KS
Practice Address - Zip Code:67056-1708
Practice Address - Country:US
Practice Address - Phone:316-835-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-79018-072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201290060AMedicaid
F09191416OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION