Provider Demographics
NPI:1346684933
Name:CAMP, LOGAN JESSICA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:JESSICA
Last Name:CAMP
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:INMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29349-8003
Mailing Address - Country:US
Mailing Address - Phone:864-578-5954
Mailing Address - Fax:864-599-5489
Practice Address - Street 1:4801 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:INMAN
Practice Address - State:SC
Practice Address - Zip Code:29349-8003
Practice Address - Country:US
Practice Address - Phone:864-578-5954
Practice Address - Fax:864-599-5489
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC204836163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool