Provider Demographics
NPI:1275925844
Name:LOGAN, CATHERINE RYAN (RN)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:RYAN
Last Name:LOGAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3929
Mailing Address - Country:US
Mailing Address - Phone:540-303-1475
Mailing Address - Fax:
Practice Address - Street 1:121 CREEKSIDE LN
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-2429
Practice Address - Country:US
Practice Address - Phone:540-303-1475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001144488163W00000X, 163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support