Provider Demographics
NPI:1083634133
Name:LOGAN, BECKY M (SURGICAL TECH)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:M
Last Name:LOGAN
Suffix:
Gender:F
Credentials:SURGICAL TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 ORMOND VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:DESTREHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70047-3717
Mailing Address - Country:US
Mailing Address - Phone:985-764-6952
Mailing Address - Fax:
Practice Address - Street 1:1101 AUDUBON AVE
Practice Address - Street 2:STE S-4
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4957
Practice Address - Country:US
Practice Address - Phone:985-447-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist