Provider Demographics
NPI:1033887757
Name:LOGAN, STEFANIE DIANE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:DIANE
Last Name:LOGAN
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 RICHARDSON LAKES DR
Mailing Address - Street 2:
Mailing Address - City:DRUMMONDS
Mailing Address - State:TN
Mailing Address - Zip Code:38023-6278
Mailing Address - Country:US
Mailing Address - Phone:901-626-6135
Mailing Address - Fax:
Practice Address - Street 1:375 RICHARDSON LAKES DR
Practice Address - Street 2:
Practice Address - City:DRUMMONDS
Practice Address - State:TN
Practice Address - Zip Code:38023-6278
Practice Address - Country:US
Practice Address - Phone:901-626-6135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000198733163WL0100X
TNL-303086163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant